Corporate Membership Registration Corporate Membership Form Company Name * Locational Address * Postal Address * Tel No(s) Tel No. * Add Remove Primary Contact Person * Email Nature of Business * Total Number of Employees * Number of Members To Be Covered Plan Types Plans * SMARTCARE MAXCARE MAXCARE PLUS ROYALCARE TPA No. of Principal Members * NO. OF DEPENDENTS * Add Remove Commencement Date * Payment Type * Quarterly Biannually Annually Disclaimer Name Job Tittle * Date * Submit