Oyi Medical Card Application

YOUR PERSONAL DETAILS Date of Birth

South African ID Passport

Passport Expiry Date

YOUR CONTACT DETAILS

YOUR HOME ADDRESS

CARD LOADING/PAYMENT OPTIONS
How do you prefer to load/pay your card?

DECLARATION 1. Oyi and its partners may contact any credit bureau (Only for Paylater Plan), the South African Fraud Prevention Services and any other person I deal with to gather and share information about my credit profile.
2. Oyi and its partners can contact me for promotional and marketing purposes.

I acknowledge and accept this declaration.

FICA & SUPPORTING DOCUMENTSDon't have all the document now? You can email to us later at docs@oyi.co.za.

ID/Passport (skip, if you don't have it now)Proof of Residence (skip, if you don't have it now)
FINALLY... Referral Code (OPTIONAL)

	Rand Amount
Accommodation:
Transport:
Food:
Medical:
Water & Lights:
Child/Spouse Maintenance:
Loans & Credit cards:
Other expenses :

	Rand Amount
Net Pay (after deductions):
Other income:

Day of month to load your card?
Monthly savings?

APPLICATION