Application Forms
GapCover Claim Application
To access the GapCover Claim Application please click on this link.
GapCover Application - Compulsory Group
To access the GapCover Application - Compulsory Group please click on this link.
GapCover Application - Voluntary Group
To access the GapCover Application - Voluntary Group please click on this link.
GapCover Application - Millennial
To access the GapCover Application – Millennial please click on this link.
GapCover Application - Intermediary
To access the GapCover Application – Intermediary please click on this link.
GapCover Application - Company
To access the GapCover Application – Company please click on this link.
Declaration of Income - Existing Member
For information on Declaration of Income for existing members , please click on link.
GapCover Application - 64 years & older
To access the GapCover Application - 64 years & older please click on this link.
NewBorn Registration
For information on Newborn registration and adding a newborn dependant please click on link.
Application for Multiply - Individual
To access the Application for Multiply – Individual please click on this link.
Application for Complementary Products - Employer
To access the Application for Complementary Products – Employer please click on this link.
Option Selection Form
For information on Option selections and option changes forms , please click on link.
Application for Complementary Products - Individual
To access the Application for Complementary Products – Individual please click on this link.
Option Selection Form - Including Declaration of Income
For information pertaining to Option Selection Form and / or Declaration of Income, please click ...
Application for Mandatory AdviseFee
To access the Application for Mandatory AdviseFee please click on this link.
Application for Conditional AdviceFee
To access the Application for Conditional AdviceFee please click on this link.
Application for HealthWaiver
To access the Application for HealthWaiver please click on this link.
Application for HealthSaver
To access the HealthSaver application please click on this link.
Examination by Pathologist or Lab
To access the Examination by Pathologist or Lab , please click on the link.
Gastro-Intestinal Questionnaire
To access the Gastro-Intestinal Questionnaire , please click on link.
Neck and Back Pain Questionnaire
To access the Neck and Back Pain Questionnaire , please click link.
Nervous Disorder Questionnaire
To access the Nervous Disorder Questionnaire , please click on link.
Respiratory Questionnaire
To access the Respiratory Questionnaire , please click on link.
Special Heart Report by Specialist
To access the Special Heart Report by Specialist , please click on link .
Employer Portal user application form
The Momentum Medical Scheme employer portal is designed to create an electronic platform for empl...