Can you afford to be ill : hospital service plan
1945 1945 1940s 15 pages : illustrations 5 If you or any of your dependants named overleaf have undergone an operation or suffered from illness of a protracted nature, kindly complete the following: (a) Patient's name (b) Period of disability from ... to ... (c) Name an...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
| Published: |
London : The London Association for Hospital Services Limited
1945, 1946
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| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/25BEB5B9-CDBA-4C39-8ACB-7BAA4E73F1AA http://hdl.handle.net/10796/423E81B1-3184-4A2C-8B82-81FF54FD8CA9 |
| Summary: | 1945
1945
1940s
15 pages : illustrations
5 If you or any of your dependants named overleaf have undergone an operation or suffered from illness of a protracted nature, kindly complete the following: (a) Patient's name (b) Period of disability from ... to ... (c) Name and address of patient's doctor who was in charge of the case (d) Nature of complaint (e) Name of Hospital or Nursing Home (if treated in an institution) 6 If you or any of your dependants are eligible to receive benefits through an approved society, an approved contributory scheme or other such fund, kindly complete the following : Name Name of Society Scheme or Fund Membership No. (if any) 7 I desire to pay my subscription : (a) Through my place of employment *Deductions will/will not be made from my remuneration weekly, monthly, quarterly. (b) *Quarterly, Half-yearly, Annually, to : Registered Office, 10, Old Jewry, E.C.2. Hon. Contributory Group Receiver M... Address *Therefore I enclose postal order, money order, cheque, banker's order for £ : : *Cross out words not applicable. I hereby declare that the foregoing answers and information supplied by me are true and correct and that I have not with-held any material information which should properly be disclosed to the Association. I understand that in accordance with the Regulations, benefit may not be allowed until a period of six months has expired from the date of the receipt of this application at the Registered Office. I agree that the Association shall accept this application for one year and that the contract shall be renewable annually subject to any variations required to be notified by me and on such conditions as may be in force at the time. I understand that the Association reserves the right to decline any application for enrolment or renewal and may impose special conditions of acceptance. Date Signature Please note that : 1. All Application Forms are subject to official acceptance. 2. Applications submitted direct to the Registered Office must be accompanied by either a remittance for at least one quarter's subscription or a Banker's Order Form. 3. Cheques, postal or money orders should be crossed and made payable to "The London Association for Hospital Services Ltd.," and Treasury Notes, Cash or Postage Stamps must not be transmitted by post.
292/842/2/63 |
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| Physical Description: | TEXT |