{"id":356,"date":"2025-03-09T17:33:08","date_gmt":"2025-03-09T17:33:08","guid":{"rendered":"https:\/\/www.mcs.co.mz\/en\/?page_id=356"},"modified":"2025-03-09T17:36:02","modified_gmt":"2025-03-09T17:36:02","slug":"seguro-de-saude","status":"publish","type":"page","link":"https:\/\/www.mcs.co.mz\/en\/seguro-de-saude\/","title":{"rendered":"Form Seguro de Sa\u00fade"},"content":{"rendered":"<div class=\"forminator-ui forminator-custom-form forminator-custom-form-337 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-337\" data-uid=\"69f27f12ce0d0\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-337\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-337 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"337\"\r\n\t\t\t\t\r\n\t\t\t\tdata-design=\"default\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tdata-grid=\"open\"\r\n\t\t\t\tenctype=\"multipart\/form-data\"\r\n\t\t\t\t\r\n\t\t\t\tstyle=\"display: none;\"\r\n\t\t\t\t\r\n\t\t\t\tdata-uid=\"69f27f12ce0d0\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Health Insurance Reimbursement Request<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69f27f12ce0d0\" id=\"forminator-field-text-1_69f27f12ce0d0-label\" class=\"forminator-label\">Health Card No. MCS<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69f27f12ce0d0\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69f27f12ce0d0\" id=\"forminator-field-text-2_69f27f12ce0d0-label\" class=\"forminator-label\">Policyholder<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_69f27f12ce0d0\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">1. PARTICIPANT\u2019S STATUS<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-337__field--select-2_69f27f12ce0d0\" id=\"forminator-form-337__field--select-2_69f27f12ce0d0-label\" class=\"forminator-label\">Select<\/label><select  id=\"forminator-form-337__field--select-2_69f27f12ce0d0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-337__field--select-2_69f27f12ce0d0-label\"><option value=\"one\"  data-calculation=\"0\">Insured<\/option><option value=\"two\"  data-calculation=\"0\">Legal Representative<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_69f27f12ce0d0\" id=\"forminator-field-name-3_69f27f12ce0d0-label\" class=\"forminator-label\">Name<\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-3_69f27f12ce0d0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69f27f12ce0d0\" id=\"forminator-field-phone-1_69f27f12ce0d0-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-1_69f27f12ce0d0\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"mz\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-9\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">2. IDENTIFICATION OF THE INSURED PERSON<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_69f27f12ce0d0\" id=\"forminator-field-name-4_69f27f12ce0d0-label\" class=\"forminator-label\">Name<\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-4_69f27f12ce0d0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"address-2\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-2-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-street_address_69f27f12ce0d0\" id=\"forminator-field-address-2-street_address_69f27f12ce0d0-label\" class=\"forminator-label\">Address<\/label><input type=\"text\" name=\"address-2-street_address\" placeholder=\"\" id=\"forminator-field-address-2-street_address_69f27f12ce0d0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69f27f12ce0d0\" id=\"forminator-field-phone-2_69f27f12ce0d0-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"E.g. +258 848191186\" id=\"forminator-field-phone-2_69f27f12ce0d0\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"mz\" data-validation=\"standard\" \/><\/div><\/div><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_69f27f12ce0d0\" id=\"forminator-field-email-2_69f27f12ce0d0-label\" class=\"forminator-label\">Email<\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"E.g. gervasiochavane798@gmail.com\" id=\"forminator-field-email-2_69f27f12ce0d0\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3. EXPENSES<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69f27f12ce0d0-label\"><span id=\"forminator-radiogroup-69f27f12ce0d0-label\" class=\"forminator-label\">Currency<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69f27f12ce0d0\" class=\"forminator-radio\" title=\"MZN\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69f27f12ce0d0\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">MZN<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69f27f12ce0d0\" class=\"forminator-radio\" title=\"USD\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69f27f12ce0d0\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">USD<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-69f27f12ce0d0\" class=\"forminator-radio\" title=\"\u20ac\"><input type=\"radio\" name=\"radio-2\" value=\"\u20ac\" id=\"forminator-field-radio-2-3-69f27f12ce0d0\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">\u20ac<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-11\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-11_69f27f12ce0d0\" id=\"forminator-field-number-11_69f27f12ce0d0-label\" class=\"forminator-label\">Hospitalization<\/label><input name=\"number-11\" value=\"\" placeholder=\"N.\u00ba of days\" id=\"forminator-field-number-11_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"number-12\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-12_69f27f12ce0d0\" id=\"forminator-field-number-12_69f27f12ce0d0-label\" class=\"forminator-label\">Hospitalization Amount<\/label><input name=\"number-12\" value=\"\" placeholder=\"Amount\" id=\"forminator-field-number-12_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"number-13\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-13_69f27f12ce0d0\" id=\"forminator-field-number-13_69f27f12ce0d0-label\" class=\"forminator-label\">Consultations<\/label><input name=\"number-13\" value=\"\" placeholder=\"Amount\" id=\"forminator-field-number-13_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-14\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-14_69f27f12ce0d0\" id=\"forminator-field-number-14_69f27f12ce0d0-label\" class=\"forminator-label\">Hospitalization - Number of days:<\/label><input name=\"number-14\" value=\"\" placeholder=\"\" id=\"forminator-field-number-14_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"number-19\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-19_69f27f12ce0d0\" id=\"forminator-field-number-19_69f27f12ce0d0-label\" class=\"forminator-label\">Medicines<\/label><input name=\"number-19\" value=\"\" placeholder=\"Amount\" id=\"forminator-field-number-19_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-21\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-21_69f27f12ce0d0\" id=\"forminator-field-number-21_69f27f12ce0d0-label\" class=\"forminator-label\">Inquiries<\/label><input name=\"number-21\" value=\"\" placeholder=\"\" id=\"forminator-field-number-21_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"number-18\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-18_69f27f12ce0d0\" id=\"forminator-field-number-18_69f27f12ce0d0-label\" class=\"forminator-label\">Orthotics<\/label><input name=\"number-18\" value=\"\" placeholder=\"Amount\" id=\"forminator-field-number-18_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-22\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-22_69f27f12ce0d0\" id=\"forminator-field-number-22_69f27f12ce0d0-label\" class=\"forminator-label\">Exams<\/label><input name=\"number-22\" value=\"\" placeholder=\"\" id=\"forminator-field-number-22_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"number-17\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-17_69f27f12ce0d0\" id=\"forminator-field-number-17_69f27f12ce0d0-label\" class=\"forminator-label\">Prosthetics<\/label><input name=\"number-17\" value=\"\" placeholder=\"Amount\" id=\"forminator-field-number-17_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-20\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-20_69f27f12ce0d0\" id=\"forminator-field-number-20_69f27f12ce0d0-label\" class=\"forminator-label\">Treatments<\/label><input name=\"number-20\" value=\"\" placeholder=\"Amount\" id=\"forminator-field-number-20_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"number-16\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-16_69f27f12ce0d0\" id=\"forminator-field-number-16_69f27f12ce0d0-label\" class=\"forminator-label\">Stomatology<\/label><input name=\"number-16\" value=\"\" placeholder=\"Amount\" id=\"forminator-field-number-16_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-15\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-15_69f27f12ce0d0\" id=\"forminator-field-number-15_69f27f12ce0d0-label\" class=\"forminator-label\">Others<\/label><input name=\"number-15\" value=\"\" placeholder=\"Amount\" id=\"forminator-field-number-15_69f27f12ce0d0\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">4. ATTACH SUPPORTING DOCUMENTS<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><ol>\n<li><strong>Examinations, Prostheses, Medications<\/strong> \u2013 Submit the Medical Prescription.<\/li>\n<li><strong>Treatments<\/strong> \u2013 Medical Prescription together with the Medical Report regarding the diagnosis of the clinical condition and its progress.<\/li>\n<li><strong>Hospitalization (Childbirth, Accident or Illness)<\/strong> \u2013 Submission of the hospitalization receipt with a breakdown of all expenses, as well as the Medical Report.<\/li>\n<li><strong>Dental treatment form (Stomatology)<\/strong> \u2013 Receipt accompanied by the treatment form, which must contain details of the treatments performed as well as the identification of the treated teeth.<\/li>\n<\/ol>\n<p data-start=\"702\" data-end=\"821\"><strong data-start=\"702\" data-end=\"711\">Note:<\/strong> The doctor\u2019s name, specialty, address, and the establishment\u2019s registration\/tax ID must be clearly legible.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_69f27f12ce0d0\" id=\"forminator-field-upload-2_69f27f12ce0d0-label\" class=\"forminator-label\">Documents<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-2_69f27f12ce0d0\"><input type=\"file\" name=\"upload-2[]\" id=\"forminator-field-upload-2_69f27f12ce0d0\" class=\"forminator-input-file forminator-field-upload-2_69f27f12ce0d0-337\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-2_69f27f12ce0d0\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-2_69f27f12ce0d0\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><p><em>Attach all original documents\/receipts\/invoices\/proof of payment, medical report, prescription, bank details, or any other documents that prove or justify the need for the reimbursement request.<\/em><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-7\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">5. REMARKS \/ REASONS<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><textarea name=\"textarea-2\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-2_69f27f12ce0d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-8\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">6. DECLARATION<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69f27f12ce0d0-label\"><label id=\"forminator-field-checkbox-1-1-69f27f12ce0d0-label\" for=\"forminator-field-checkbox-1-1-69f27f12ce0d0\" class=\"forminator-checkbox\" title=\"The information provided is accurate, truthful, and given in good faith, and I take full responsibility for it.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-69f27f12ce0d0\" aria-labelledby=\"forminator-field-checkbox-1-1-69f27f12ce0d0-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">The information provided is accurate, truthful, and given in good faith, and I take full responsibility for it.<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69f27f12ce0d0-label\" for=\"forminator-field-checkbox-1-2-69f27f12ce0d0\" class=\"forminator-checkbox\" title=\"I authorize the Insurer to collect additional personal data from public entities, specialized companies, and other economic units, in order to confirm or complement the collected elements necessary for managing the contractual relationship. The client is responsible for any omissions, inaccuracies, or false information provided. Access to the provided personal data will be strictly confidential, provided that it is compatible with the purpose of its collection.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-69f27f12ce0d0\" aria-labelledby=\"forminator-field-checkbox-1-2-69f27f12ce0d0-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I authorize the Insurer to collect additional personal data from public entities, specialized companies, and other economic units, in order to confirm or complement the collected elements necessary for managing the contractual relationship. The client is responsible for any omissions, inaccuracies, or false information provided. Access to the provided personal data will be strictly confidential, provided that it is compatible with the purpose of its collection.<\/span><\/label><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit Refund Request<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"9603bae5ca\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/356\" \/><input type=\"hidden\" name=\"form_id\" value=\"337\"><input type=\"hidden\" name=\"page_id\" value=\"356\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.mcs.co.mz\/en\/seguro-de-saude\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-formularios.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-356","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/356","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/comments?post=356"}],"version-history":[{"count":4,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/356\/revisions"}],"predecessor-version":[{"id":364,"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/pages\/356\/revisions\/364"}],"wp:attachment":[{"href":"https:\/\/www.mcs.co.mz\/en\/wp-json\/wp\/v2\/media?parent=356"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}