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    NHIF 26 Amendment Form

    Uploaded by

    Sue Awuonda
    This document is an application form for amending or updating details with the National Hospital Insurance Fund (NHIF) in Kenya. It requests information such as the member's name, ID number, address, and the changes being requested. To change a spouse's name, the form requires copies of ID cards for the member and spouse, as well as a marriage certificate or affidavit. The form also collects details of up to 10 children, including their names, dates of birth, gender, and birth or adoption certificate numbers. Applicants must attach photos of all individuals listed and certify the accuracy of the provided information. NHIF officials must verify and process the request with the member present.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    NHIF 26 Amendment Form

    Uploaded by

    Sue Awuonda
    91 views2 pages
    This document is an application form for amending or updating details with the National Hospital Insurance Fund (NHIF) in Kenya. It requests information such as the member's name, ID number, address, and the changes being requested. To change a spouse's name, the form requires copies of ID cards for the member and spouse, as well as a marriage certificate or affidavit. The form also collects details of up to 10 children, including their names, dates of birth, gender, and birth or adoption certificate numbers. Applicants must attach photos of all individuals listed and certify the accuracy of the provided information. NHIF officials must verify and process the request with the member present.

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    This document is an application form for amending or updating details with the National Hospital Insurance Fund (NHIF) in Kenya. It requests information such as the member's name, ID number, address, and the changes being requested. To change a spouse's name, the form requires copies of ID cards for the member and spouse, as well as a marriage certificate or affidavit. The form also collects details of up to 10 children, including their names, dates of birth, gender, and birth or adoption certificate numbers. Applicants must attach photos of all individuals listed and certify the accuracy of the provided information. NHIF officials must verify and process the request with the member present.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    91 views2 pages

    NHIF 26 Amendment Form

    Uploaded by

    Sue Awuonda
    This document is an application form for amending or updating details with the National Hospital Insurance Fund (NHIF) in Kenya. It requests information such as the member's name, ID number, address, and the changes being requested. To change a spouse's name, the form requires copies of ID cards for the member and spouse, as well as a marriage certificate or affidavit. The form also collects details of up to 10 children, including their names, dates of birth, gender, and birth or adoption certificate numbers. Applicants must attach photos of all individuals listed and certify the accuracy of the provided information. NHIF officials must verify and process the request with the member present.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    NHIF 26

    Revised 2018

    NATIONAL HOSPITAL INSURANCE FUND


    P.O. Box 30443, NAIROBI
    Tel: 020 2723281/82
    Email: [email protected]
    Website: www.nhif.or.ke

    APPLICATION FOR AMENDMENT/UPDATES


    PART I: To be completed by the principal member who should be present in person in case
    of declaration/change of spouse details

    a) Member Name:..............................................................................................................................................
    b) Member No:............................................I.D No.............................................................................................
    c) Postal Address:......................................Code:.............................................................................................
    d) Telephone No:........................................Email:.............................................................................................
    e) Requested Changes:
    ......................................................................................................................................................................
    ......................................................................................................................................................................

    REQUIREMENTS
    To change / insert the name of a spouse the following documents must be included:-
    • Copies of I.D cards for Member and Spouse (Copies should be certified / endorsed by member).
    • Marriage Certificate or Affidavit from Magistrates Court or from an advocate who is a Commissioner of
    Oaths, confirming relationship (Copy should be certified / endorsed by the member)
    NB:
    In case of change of wife / husband the new spouse will only access benefits after 28 days from the date
    amendment is done

    PART II: CHILDREN’S PARTICULARS

    Date of Birth Birth Certificate No.


    Gender
    Name of Child Notification No.
    Date Month Year (M/F)
    Adoption Cert. No.

    1.

    2.

    3.

    4.

    5.

    6.

    7.

    8.

    9.

    10.

    Please attach copies of Birth / Adoption Certificate.


    Birth Notification is only acceptable for children below 6 months.
    NHIF 26
    Revised 2018
    PART III: PHOTOGRAPHS

    Please attach colored passport size photographs for each of the person named in PART I and II, indicate the
    name of the person below as appropriate.

    Spouse Name Child’s Name Child’s Name

    .................................................................... .................................................................... ....................................................................

    Child’s Name Child’s Name Child’s Name

    .................................................................... .................................................................... ....................................................................

    In case the family has more then five (5) children kindly use / attach another form (NHIF 26) and complete
    PART III for the additional beneficiaries.

    PART IV: Certification

    I certify that the information provided above is correct to the best of my knowledge.

    Name of Contributor................................................................ Sign...................................Date................................

    For official user only

    1. Receiving Officer__________________________________________ Sign ______________ Date ___________

    2. Verification Officer_________________________________________ Sign ______________ Date ___________

    3. Amending Officer_________________________________________ Sign ______________ Date ___________

    4. Photo processing Officer ___________________________________ Sign ______________ Date ___________

    * The receiving, verifying and amending officers should confirm that the application is in order and that the
    member has presented it in person before processing the request.

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