Kabayan Online Application Form

Step 1 of 2

Terms and Conditions

The MediCard Kabayan accepts payments via credit card/debit card - Master Card or Visa. Payments are not collected by the MediCard Kabayan directly, but by a Service Provider. By agreeing to these terms and conditions, you acknowledge that the website used for your transaction is maintained and administered by the Service Provider. You will also be asked to submit appropriate personal and financial information to the Service Provider so that the online payment can be processed.

Your payment is not complete until you click the "submit" button. The MediCard Kabayan will send an electronic acknowledgement to you that the transaction has occurred. You will receive a formal receipt from the MediCard Kabayan in the mail.

Your payment will normally reach the MediCard Kabayan bank account, to which you are making a payment, within 3 days.

We cannot accept liability for your money not reaching the MediCard Kabayan bank account due to your quoting incorrect personal details, or due to your credit/debit card supplier refusing or declining payment.

By agreeing to these terms and conditions, you accept and consent to your personal data being provided to the Service Provider for sole purpose of offering and administering the online payment. The MediCard Kabayan respects the privacy of every individual who visits our site and MediCard Kabayan websites contain security measures in place to protect the loss, misuse and alteration of the information under our control. Communications to and from the Service Provider’s site are encrypted.

If you have any questions or concerns, please contact the MediCard Kabayan via e-mail to kabayanagent@medicardphils.com.

Important security note: Never transmit credit card information by e-mail.

SPONSOR'S PERSONAL INFORMATION

Principals/Sponsors who will enroll any dependents or beneficiaries are deemed to have secured the proper consent from the said dependents or beneficiaries that they have been designated as such.

Agent Name

Family Name(Required)

First Name(Required)

Middle Initial

Birthdate(Required)

Place of Birth(Required)

Nationality(Required)

Sex(Required)

Mobile Number(Required)

Email Address(Required)

Present Address (Unit/Bldg Number,Street,Subdivision,Barangay):(Required)

City:(Required)

Province:(Required)

Same As Present

Same as Present

Permanent Address (Unit/Bldg Number,Street,Subdivision,Barangay)(Required)

City(Required)

Province(Required)

Permanent Address (Same As Present)

City (Same As Present)

Province (Same As Present)

Group/Company(Required)

Nature of Work(Required)

TIN (if applicable):

SSS Number (if applicable):

Source of Income

Proof of Identification(Required)

ID Number(Required)

Government ID(Required)

Max. file size: 2 GB.

Communications will be sent through your given email, mobile number, or address. Should you need to update any information or contact details, please get in touch with us via email to: mgabat@medicardphils.com and copy furnish: kfvillanueva@medicardphils.com.

Data Privacy Terms: In compliance with Republic Act 10173 also known as the Data Privacy Act of 2012; and its implementing Rules and Regulations, We need your Consent to: (a) allow us to collect, process, or share your information with our accredited healthcare providers who may also be responsible in rendering appropriate medical services to you, and (b) to share utilization data with your Principal (in case of dependents);

To the extent our capacity to render our services to you is affected, the withholding or withdrawal of such Content shall relieve us from our obligation to deliver the appropriate services to you.

You are afforded with certain rights and protection in accordance with the said Act and you may visit https://www.medicardphils.com/privacy-notice or email privacy@medicardphils.com for more information.