Subscription

KWHIA Health Care Subscription

FAQs

Subscription

KWHIA Health Care Subscription

FAQs

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Step 1 of 6 - Community Information

LGA(Required)

Ward

Community(Required)

HCP (Health Care Provider)(Required)

Hidden

Subscription Status

Surname(Required)

First Name(Required)

Middle Name

Gender(Required)

Date of Birth(Required)

Marital Status(Required)

Number of Children(Required)

Email(Required)

Phone Number(Required)

Identity Card(Required)

ID Card Number(Required)

Tax Number

Passport Photograph(Required)

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 1 MB.

Title(Required)

Alias

Mother's Maiden Name(Required)

Place of Birth(Required)

Nationality(Required)

State of Origin(Required)

Residential Address

Nearest Landmark(Required)

Mailing Address

Employment Status(Required)

PSN

Verification Number

MDA (Ministry/Department/Agency

Payroll

Employer

Employee Number

Spouse Details

Surname(Required)

First name(Required)

Middle Name

Gender(Required)

Date of Birth(Required)

Phone Number

HCP (Health Care Provider)

Identity Card (Spouse)

ID Card Number (Spouse)

Passport Photograph

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 1 MB.

Child 1 Details

Surname(Required)

First name(Required)

Middle name

Gender(Required)

Date of Birth(Required)

Passport Photograph

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 1 MB.

HCP (Health Care Provider)

Child 2 Details

Surname(Required)

First name(Required)

Middle name

Gender(Required)

Date of Birth(Required)

Passport Photograph

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 1 MB.

HCP (Health Care Provider)

Child 3 Details

Surname(Required)

First Name(Required)

Middle Name

Gender(Required)

Date of Birth(Required)

Passport Photograph

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 1 MB.

HCP (Health Care Provider)

Child 4 Details

Surname(Required)

First Name(Required)

Middle Name

Gender(Required)

Date of Birth(Required)

Passport Photograph

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 1 MB.

HCP (Health Care Provider)

This field is for validation purposes and should be left unchanged.