2025 Healthcard Withdrawal: Individual M

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Agility Healthcard Annual Withdrawal: 2025

Dear Agility Healthcard Member

Please complete the form below should you wish to withdraw funds from your Agility Healthcard.

To view your Healthcard balance, visit www.whatsonmycard.com and enter your 16-digit card number (on the front of the Healthcard) to view your balance online.

Withdrawal requests will be accepted from 16 October 2025 to 7 November 2025. Please note that no submissions will be processed after 7 November 2025.

Before submitting the form, please ensure to upload the required supporting documents: a recent bank statement or a bank-stamped confirmation of your account (dated within the last three months), along with a copy of your ID, valid driver’s license, or passport.

First name

Last name

Contact number

Company name (If part of an employer group)

ID number

Please insert your 16-digit card number

Name of Bank

Branch name

Account type

Branch code

Account holder name & surname

Account number

Withdrawal option 1: Do you want to withdraw the full available amount?

Yes

Remember that R200 will remain in your Healthcard to ensure the account stays active

Withdrawal option 2: Do you wish to specify the amount to be withdrawn? Please confirm the amount below.

Remember that R200 will remain in your Healthcard to ensure the account stays active

Please upload a recent bank statement or bank stamped confirmation of your account (no older than three months)

Please upload a copy of your ID document, valid drivers licence or passport

Disclaimer:

By submitting this form, the Agility Healthcard accountholder confirms that all details are correct and authorises the withdrawal. Agility Healthcard and its affiliates The authorisation to withdraw funds will be processed in accordance with the information provided. Once the funds have been withdrawn, they cannot be reversed, and Agility Healthcard shall not be responsible for any consequences arising from the authorised withdrawal.

Withdrawals from the Agility Healthcard are subject to the terms and conditions set out by Agility Insurance Administrators and the card's issuing bank, Standard Bank. Agility is not liable for any delays or transaction failures caused by third-party payment processors or network providers. Users are advised to ensure adequate funds are available before initiating withdrawals. Any discrepancies or disputes must be reported within 30 days of the transaction.

The accountholder understands and agrees that Agility Healthcard reserves the right to request additional documentation or verification if necessary. Use of the Agility Healthcard is subject to the terms and conditions outlined in the agreement with Agility Healthcard, which may be updated from time to time.

Disclaimer acceptance

I agree