Are you being assisted by a Kabayan agent?
If yes, please indicate the agent code and verify the name:
SPONSOR'S PERSONAL INFORMATION
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 www.medicardphils.com/privacy or email email@example.com for more information.
You will be receiving an e-mail to proceed with your application.