Corporate Membership Registration Corporate Membership Form Company Name * Locational Address * Postal Address * Tel No(s) Tel No. * plus1 Add minus1 Remove Primary Contact Person * Email Nature of Business * Total Number of Employees * Number of Members To Be Covered Plan Types Plans * SMARTCAREMAXCAREMAXCARE PLUSROYALCARETPA No. of Principal Members * NO. OF DEPENDENTS * plus1 Add minus1 Remove Commencement Date * Payment Type * Quarterly Biannually Annually Disclaimer Name Job Tittle * Date * If you are human, leave this field blank. Submit