IDENTITY CARD REQUEST FORM

You can also click download PDF form and complete it manually, then send it to forms@vhcl.com.ng


    To be completed in CAPITAL LETTERS
    Please complete the form as appropriate.
    Note the red asteriks * for the required fields.
    Thank you for chosing Veritas Healthcare Ltd.

    Do you have Children registered with us?

    Another Child?

    Another Child?

    Another Child?

    This is the last, you are allow to add only 4 children in a plan. Thank you.

    Note: The Information provided shall be kept with utmost confidentiality and shall be used for no other purpose than HMO Registration.