Individual Membership Application

1. Principal Member: Your Personal Details

Membership Number

Specify date you want cover to start(the cover must start on the 1st of the preferred month)

Date of Birth

Title

First name(s)

Surname

ID/ Passport No

Gender

Male

Female

Nationality

Marital Status

Single

Married

Divorced

Educational Background

Certificate

Diploma

Degree

Master

PHD

Others

Home Phone

Contact Number

Work Phone

Alternative Number

Preferred Email Address

Postal Address

Physical Address

2. Dependants (to be included in the membership)

Re-order	Full Name	Date of Birth	ID / Passport Number	Relation to Main Member	Weight	Operations
	Full Name	Date of Birth	ID / Passport Number	Relation to Main Member	Item weight

more items

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