- Kabayan - Medicard Philippines, Inc.

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New Sponsor

Are you being assisted by a Kabayan agent?

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If yes, please indicate the agent code and verify the name:

* Please indicate Agent Code:

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SPONSOR'S PERSONAL INFORMATION

Principals/Sponsors who will enroll any dependents or beneficiaries are deemed to have secured the proper consent from the said dependents or beneficiaries that they have been designated as such.

* Family Name
* First Name
* Middle Initial
* Birthdate
* Place of Birth
* Nationality
* Contact Number	-

* Email Address
Present Address
* Unit/Bldg./No./Street
* City
* State/Province
* Country
Permanent Address
* Street
* City
* Province
* Country
* Group/Company
* Nature Of Work
* TIN (if applicable)
* SSS Number (if applicable)
* Source Of Income	EMPLOYED
	PENSION
	SELF EMPLOYED
	OTHERS

* Proof of Identification
* ID No.
* Required fields.

Communications will be sent through your given email, mobile number, or address. Should you need to update any information or contact details, please get in touch with us via email to: mgabat@medicardphils.com and copy furnish: kfvillanueva@medicardphils.com.

Data Privacy Terms:

In compliance with Republic Act 10173 also known as the Data Privacy Act of 2012; and its implementing Rules and Regulations, We need your Consent to: (a) allow us to collect, process, or share your information with our accredited healthcare providers who may also be responsible in rendering appropriate medical services to you, and (b) to share utilization data with your Principal (in case of dependents);

To the extent our capacity to render our services to you is affected, the withholding or withdrawal of such Content shall relieve us from our obligation to deliver the appropriate services to you.

You are afforded with certain rights and protection in accordance with the said Act and you may visit Privacy Notice or email privacy@medicardphils.com for more information.

By ticking the box, we will consider that you agree to give your Consent to us.
I have read and fully understood the terms of the Memorandum of Agreement

A portion of your renewal fee can be on us. Interested?
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You will be receiving an e-mail to proceed with your application.

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Interested individuals may also call the following toll free number:
1-800-8944-8400 for Globe mobile/landline & Touch Mobile subscribers
1-800-1888-9001 for PLDT subscribers outside Metro Manila