Fin301 Life/Health C/A Application
Health Authority - Abu Dhabi
Health System Financing
Insurance Company Letter of Request
to be an Authorized Health Insurer participating in the Health
Insurance scheme in the Emirate of Abu Dhabi
To: Director of Health System Financing Division, HAAD
Dear Sir,
We, ……………………………………………………… practicing in the UAE as an Insurance Company, request approval for our company to be authorized as a Health Insurer in the Emirate of Abu Dhabi.
We hereby agree to adhere to the Health Insurance Bylaws & regulations of the Emirate
of Abu Dhabi along with all current and future requirements of HAAD, committing to
provide health services in accordance with professional and ethical standards.
We hereby confirm that all information submitted and attached to this request is correct and complete, and we reiterate that we have submitted all the necessary supporting documents with this request. We agree to submit for review all our records and documents upon request.
Yours sincerely,
Mr./ Mrs. …………………………………. title: …..…………………… is hereby authorized to represent our company and sign the documents as necessary
Signature: ……………….………………………. Date: / /
Company’s official seal:
- C2-
APPLICATION FOR AUTHORIZATION
To be an authorized Insurer participating in
The Health Insurance scheme
To HAAD Health System Financing Division;
Date of application: ______
Company license no.: ______(Ministry of Economy)
Company license no.: ______(Department of Planning & Economy – Abu Dhabi)
______
(Name of applying insurance)
Mailing address: ______
(City) (Emirate)
______
(Office phone) (Fax number) (E-mail)
We hereby apply for authorization to offer the types of health insurance plans listed below in the Emirate of Abu Dhabi:
Basic compulsory plan:
Enhanced plans:
We hereby confirm that all information submitted with this request is correct, and we reiterate that we have submitted all necessary supporting documents with this request.
(Company seal) ______
Insurance Company Manager’s Name & Signature
- C3-