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Return the form with original invoices to:
GlobalCapital Health Insurance Agency Limited, Testaferrata Street, Ta' Xbiex XBX 1403 Malta

Members wanting to upgrade should also use this form. Please ensure you sign and date the declaration on the back of the form

Application by an existing subcriber to add dependants. Eligible dependents are:

  • wife/husband/partner under 65 years of age
  • children under 21 years of age

Membership is only available to Maltese residents. Please sign the form to confirm your residence.

 Pre-authorise your treatment by stating the procedure code

All Bupa Malta claims that are valid and covered can now be settled via direct credit to your bank account if you wish.