Section 1: Personal details

  • Mr
  • Mrs
  • Ms
  • Other

Postal address


Section 2: Claim details

Beneficiary Name

Treatment date

Provider name

Practice number

Amount claimed

It is very important that the medical aid statement reflecting the claims submitted, the hospital account and the doctor's statements are provided with this claim! If these documents are not attached it will be considered an invalid claim.

Section 3: Required Documentation

The following documentation is required BEFORE a claim can be processed:

First 2 pages of Hospital Account
Medical Aid Statement
Doctor / Service Provider Statement
  • Upload file 1
  • Upload file 2
  • Upload file 3
  • Upload file 4
  • Upload file 5
  • Upload file 6

Please use the tick boxes above to ensure you have included the required documentation.

Section 4: Policy Holder's banking details - for claims refund process

  • Cheque
  • Savings
  • Transmission
As per the terms and conditions of this policy all the required information must be submitted to TRA within 3 months of the date of medical aid processing the claim after which the claim will be considered "stale". Refunds are generally made directly into the policyholder's bank account.

I declare that the aforegoing details are, to the best of my knowledge true, correct and complete:

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