Edit, Download, and Sign the Individual Application Form for Basic (Abu Dhabi) Plan
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How do I fill this out?
To fill out this form, please follow the given instructions carefully to ensure all required fields are properly completed. Use CAPITAL LETTERS and provide accurate information to avoid any issues with your application. Make sure to review each section and check for any additional documents needed.
How to fill out the Individual Application Form for Basic (Abu Dhabi) Plan?
1
Start by completing the 'Policy Type' section to indicate whether it's a new policy or renewal.
2
Provide the requested policy information including current policy number and effective/expiry dates.
3
Fill in the 'Policyholder Information' with the necessary details such as name, contact information, and Emirates ID.
4
Add the required 'Member(s) Details' for each individual under the policy.
5
Ensure to review the declarations and sign the form where indicated.
Who needs the Individual Application Form for Basic (Abu Dhabi) Plan?
1
Individuals applying for health insurance coverage under the Basic Abu Dhabi Plan.
2
Policyholders renewing their current Basic Abu Dhabi Plan.
3
Sponsors or employers needing to provide health insurance for dependents.
4
Residents of Abu Dhabi who meet the eligibility criteria for the Basic plan.
5
Individuals without any other health insurance coverage seeking the Basic Abu Dhabi Plan.
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What are the instructions for submitting this form?
Submit the completed form and required documents via the following methods: Email to services@damanhealth.ae, Fax to 600-532258, Online submission form available at damanhealth.ae, or Mail to Daman Health Office, Abu Dhabi, PO Box 128888, UAE. Ensure to attach all necessary supporting documents to avoid delays in processing. For additional guidance or assistance, contact Daman customer service at 800-432626.
What are the important dates for this form in 2024 and 2025?
Important dates for this form include the policy effective date, expiry date, and the deadline for submitting required documents within 60 days of issuance in 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to facilitate the application and renewal process for the Basic Abu Dhabi health insurance plan. Applicants need to provide accurate policyholder and member details, along with necessary supporting documents. This ensures compliance with the Health Insurance Law No. 23/2005 and its Executive Regulations No. 25/2006.
Tell me about this form and its components and fields line-by-line.
- 1. Policy Type: Indicates whether the application is for a new policy or renewal.
- 2. Policy Information: Includes current policy number and effective/expiry dates.
- 3. Policyholder Information: Details of the policyholder including name, contact information, and Emirates ID.
- 4. Member(s) Details: Information about each member covered under the policy.
- 5. Declarations: Statements declaring the accuracy and completeness of the information provided.
What happens if I fail to submit this form?
Failure to submit this form can result in loss of insurance coverage and other penalties as per the applicable laws. Completing and submitting the form on time is crucial.
- Loss of Coverage: Delay in renewal can result in loss of continuity and penalties.
- Policy Termination: Incomplete or missing documents can lead to policy termination.
How do I know when to use this form?
- 1. New Application: For individuals applying for the Basic Abu Dhabi Plan for the first time.
- 2. Policy Renewal: For renewing an existing Basic Abu Dhabi Plan.
- 3. Adding Dependents: To include new dependents under the policy.
Frequently Asked Question
What is the purpose of this form?
This form is used to apply for or renew the Basic Abu Dhabi health insurance plan.
How do I fill out the form?
Fill out the necessary fields in CAPITAL LETTERS, provide accurate information, and review each section for completeness.
Can I edit the form on PrintFriendly?
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Use PrintFriendly's integrated e-signature feature to add your digital signature to the form.
What should I do if I have more dependents than the form allows?
Please attach an additional sheet with the details of all dependents.
Do I need to provide any additional documents?
Yes, you may need to provide a passport copy, residence visa copy, and valid EID card.
How can I submit the completed form?
You can submit the form via email, fax, online submission form, or mail to the specified address.
What happens if I fail to submit the required documents?
Failure to submit required documents may result in termination of the policy.
Who needs to use this form?
Individuals applying for or renewing the Basic Abu Dhabi Plan, sponsors, and employers who need to provide insurance for dependents.
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