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Registration Form

Register as :

Name of requester
Provider name
Name of Employee
Current Position
Login username
Telephone No
Email Address
Fax number
Mobile No

Member - is a person currently insured under any schemes of Bupa Arabia. He may also be referrend  as a policy holder.

- you may register as our provider if you are an authorized staff from one of Bupa Arabia's healthcare providers.
*Upload Supporting Documents  

Please attach official request letter bearing official stamp and signature from your department

I acknowledge that the above information are correct and accurate, and I confirm my adherence to the Terms and Condition of Bupa Arabia’s web services and Cybersecurity as stated in Appendix (6) of the Policy, and I bear full responsibility for the use of the portal of Bupa Arabia for Cooperative Insurance Company and I pledge my full commitment to all applicable laws and regulations.
اقر بأن البيانات الواردة أعلاه صحيحة وباطلاعي والتزامي بشروط وأحكام استخدام خدمات بوبا العربية الالكترونية والامن السيبراني والواردة في الملحق (6) من الوثيقة، وبانني أتحمل كامل المسؤولية عن استخدام البوابة الإلكترونية لشركة بوبا العربية للتأمين التعاوني وأتعهد بالتزامي الكامل بجميع القوانين واللوائح المعمول بها

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