Debit Order

Membership Number

1. Member Details - To be completed by principal member

Name of Principal Member

Membership No

Health Plan

Access

Comprehensive

Executive

Prestige

Level of Cover

Core

Plus

Extra

Max

No. of registered Dependants

Monthly Subscription Rate

Email Address

Postal Address

Home Phone

Contact Number

Work Phone

Alternative Number

Call Us : 3633100

Gaborone

Plot 50638, Fairgrounds, Gaborone
P O Box 632, Gaborone, Botswana
BOMAID, 8WCF+J3F, Gaborone
Tel: +267 318 3100, +267 363 3101
Email: bomaid@bomaid.co.bw

Francistown

Plot 21931/21932
Tebo House, Ground Floor
P.O.Box 3328, Francistown, Botswana
Tel: +267 241 0316
Email: bomaid@bomaid.co.bw

Maun

Engen Center - New Mall Plot 1196
Tel: +267 686 4577
Email: bomaid@bomaid.co.bw