"*" indicates required fields Update My Information Please select the relevant type of information you would like to update from the list below. You can select multiple sections. Info Selection* Personal Information Contact Information Medical Scheme Information Banking Details Addition Of Dependents Removal Of Dependents Select info to update* Contact Information Medical Scheme Information Banking Details Addition Of Dependents Removal of Dependents Once you have selected the relevant section you would like to update please click "Next" to proceed. What to do Please populate the below fields with your latest information in order for us to update our records. Personal InformationName First Last Date of BirthYearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031ID or Passport numberPolicy Number*Contact InformationCell PhoneAlternative Contact NumberPrimary Email Secondary Email Medical Scheme InformationMembership NumberMedical SchemePlease select your Medical SchemeGemHealthNammedNAPOTELNHP(Namibia Health Plan)NMC (Namibia Medical Care)RMA(Renaissance Health)Benefit OptionPlease select your planGemHealthActiveEssentialStandardComprehensiveTraumaBasicNAPOTEL MAINNAPOTEL LITEGoldPlatinumTitaniumSilverBronzeHospitalBlue DiamondLitunga PrimaryAmberAmber PlusEmeraldEmerald PlusRubyJadeOpalSapphireTopazTopaz PlusPrestige CareStatus CareCaliber CareEsteem CareEvolve CarePremier CareBanking DetailsBankPlease select your bank from the listBank WindhoekFirst National Bank of Namibia (FNB)Letshego Bank NamibiaNedbank NamibiaStandard Bank NamibiaTrustco Bank (TBN)Name of Account Holder First Last Account TypeCurrentSavingsTransmissionBranch CodeAccount NumberConsent* I understand and acceptI confirm that I accept this Authority and Mandate and that I’m bound by the payment terms applicable to this policy agreement. I authorise Hollard Life Assurance Company to debit all monthly premiums due on this policy against the above bank account on the 1st day of each month. If a payment is unsuccessful, I authorise Hollard Life Assurance Company to re-present the debit instruction against the same account to meet my obligations under this agreement. If two (2) consecutive debit order collections are unsuccessful, Hollard Life Assurance Company may cancel the policy in accordance with the policy terms and applicable notice requirements.Addition of DependentsAdd Dependents Name & Surname Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Removal of DependentsRemove Dependents Name & Surname Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Data Protection and Privacy Declaration By providing the information in this form, you agree that Cinagi (Pty) Ltd on behalf of Hollard Life Namibia may: use the personal information provided to administer your policy and to provide insurance and related services to you. share this information with service providers, intermediaries, administrators, reinsurers, and other parties where reasonably necessary for underwriting, policy administration, claims handling, regulatory compliance, and related insurance services. communicate with you electronically regarding policy administration, service notifications, policy amendments, premium changes, and other information relating to your cover. store or process your personal information outside Namibia where reasonably necessary for the administration of insurance services, including the use of secure cloud-based systems and service providers. process the personal information of your spouse and/or dependants where you have included them in your application, for the purposes of administering and activating the policy and servicing any claims. You further confirm and agree that: where you provide personal information relating to your dependants or any other person, you confirm that you are authorised to provide such information and that it may be processed for the purposes described in this declaration and in our Privacy Policy. where consent is provided on behalf of a person under the age of 18 years, you confirm that you are a parent, legal guardian, or otherwise authorised to provide such consent on their behalf. You also acknowledge that you have read and understood the applicable Privacy Policy and consent to the processing of personal information as described therein. Consent* I agree to above Data Protection and Privacy Declaration