1.Medical Claims Authorisation Form for Single Usage (W.e.f. 30 June 2015)  

Click here to download the form. The Medisave Account Holder and/or patient can refer to this guide and complete the form at home, sign the document and bring the completed form to our Financial Counsellors at the polyclinic during the next visit. 

 

2.Medical Claims Authorisation Form for Multiple Usage (W.e.f. 30 June 2015)

Click here to download the form. The Medisave Account Holder and/or patient can refer to this guide and complete the form at home, sign the document and bring the completed form to our Financial Counsellors at the polyclinic during the next visit.   

 

3.Revocation Form for Medical Claims Authorisation (W.e.f. 30 June 2015)

Click here to download the form and instructions. 

 

Important notes for Medical Claims Authorisation Forms:

Please ensure that you have completed the following COMPULSORY items in the Medical Claims Authorisation Forms and/or taken the necessary actions before visiting our polyclinics:   

  • Minimum age for CPF account holder for authorised Medisave withdrawal had been increased from 18 to 21 years old. 
  • Account holders below 21 years of age shall have an accompany signatory from Parent*/Legal Guardian*/Foster Parent^  

 

 *Supporting documents required under Parent/ Legal Guardian: 

  • Copy of NRIC (front and back) of Parent/ Legal Guardian 
  • Copy of Birth Certificate of account holder (NRIC or SAF Card is acceptable) 

^ Supporting documents required under Foster Parent: 

  • Copy of MSF’s Foster Care documents