• Request for Duplicate Policy and Health Card

Request for Duplicate Policy and Health Card

It is a submission to reprint the policy book and health card. Reprinting will be charged, for the book of Rp 75.000, - while the health card is Rp 60.000, -.

Duplicate Procedure Policy and Health Card:

  1. Fill out Form of Lost Statement / Letters Statement of loss of Admedika card (form attached) and signed by the policy holder on the seal
  2. Attach a valid copy of valid Identity Cardholder (KTP / SIM / Passport) card and proof of payment of administration redistribution fee or duplicate health card
  3. Attach a letter of loss of policy book from a police office
  4. Submit the document to the marketing office / Regional Service Center / National Service Center

Forms:

Request for Duplicate Policy and Health Card Form

Sequis Services

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