Membership Form

Online Membership

Price are apply to all new memberships and the existing ones will increase on the applicable anniversary.

First Name *

Last Name *

ID No: *

Phone

Email Address

Street Address

City

State/Province

ZIP / Postal Code

Household Membership 6 persons Pensioner 2 persons MaxHousehold membership Pensioner Membership

Main Member

Dependent 1

Dependent 2

Dependent 3

Dependent 4

Choose your Membership TypeHousehold with Hospital Transport CoverHousehold without Hospital Transport CoverPensioner with Hospital Transport CoverPensioner without Hospital Transport Cover

PaymentStop OrderDirect DepDedit OrderMethod Of Payment

Consent *

I certify that I have read the overleaf agreement and consent thereto:

DOWNLOAD OUR EMEGENCY MEDICAL POLICY COVER

BECOME A MEMBER AND LET US SAVE A LIFE

APPLY NOW

Potmab Medics is an emerging 100% black owned Emergency medical service company targeting film, event and responding to all priority calls when needed by other stakeholders. The business was established in 2018 with the aim to be perfect BEE Partners.

Official info

Call : 066 327 8311
Email : info@potmabmedics.co.za
Address : 5A Bower Street, Mandalay, 7785

Membership Form

Online Membership

Price are apply to all new memberships and the existing ones will increase on the applicable anniversary.

BECOME A MEMBER AND LET US SAVE A LIFE

Official info

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