3.3 To arrange for the payment of funds from the Minister, the Applicant shall complete and provide to the Minister a
Claim Form for each respective Treatment and all documents and forms as prescribed by the Schedule.
Documentation requirements may differ according to Treatment.
Confirm eligibility (see terms and conditions)
2. Fill out this form completely. Incomplete information will delay or
disqualify your application.
3. Mail this application with original copies of your proof of in