I, in my capacity as the Sponsor of the person/persons detailed in this application (the “Member(s)”), \ do hereby declare, acknowledge and confirm the relevant declarations held below, with respect to this Individual Basic plan (“Basic”) renewal application for the Member(s).
All person/persons listed in this application are eligible for the Basic in accordance with Law as they are earning total monthly salary within/up to AED 4,000 with accommodation or AED 5,000 without accommodation.
The Member is my dependent and is not working in the UAE and I hereby undertake to notify Daman immediately if the employment status of the Member changes.
The marital status I have declared for the Member is true and correct and I will notify Daman if the Member’s marital status changes during the policy term.
The Member is my spouse. My spouse does not have any other health insurance and is not working. I will cancel my spouse’s Basic (Abu Dhabi) plan and apply for the Thiqa programme for my spouse within 60 days after completing the visa process.
The Member is not working in the United Arab Emirates and if the employment status of the Member changes, I will notify Daman immediately.
I am sponsoring my own children under the age of 18 years.
The Member is my dependant and she is not married. If her marital status changes, I will notify Daman immediately.
The Member’s husband is not residing in the United Arab Emirates. I will notify Daman immediately if he becomes a resident of the United Arab Emirates.
The Member is not working in the United Arab Emirates and if the employment status of the Member changes, I will notify Daman immediately.
The information and documents submitted to Daman under this online application form are complete, true and correct and understand that it is unlawful to provide false, incomplete and/or misleading facts and information (misrepresentation) to Daman. I understand that such act may lead to imprisonment, fines, denial of coverage, loss of benefits and legal damages in addition to any other consequences specified in the insurance policy.
If any of the Member’s passport/visa is expired at the time of this application, I will submit the renewed passport / visa copy within 30 days from the date of this application. I understand that if I fail to do so, Daman will cancel the insurance coverage of the Member and I will be held liable to reimburse Daman for any claim payments made under the cancelled insurance coverage.