Email: cifteammaxicare 2026

1. Click ‘Get Form’ to open the Customer Information Form in the editor.
2. Begin by filling out the Member General Information section. Enter the Cardholder’s Name, Maxicare Card No., T.I.N., Mobile No., and other personal details as required. Ensure all information is written in PRINT.
3. Complete the Present Address and Permanent Address fields. If both addresses are the same, check the corresponding box for convenience.
4. Indicate your Civil Status, Gender, Citizenship, Educational Attainment, and Occupation. This information is crucial for your profile.
5. Select your Source of Fund by checking the appropriate box that applies to you.
6. Attach a photocopy of a valid ID as specified in the form. Check the box next to your selected ID type.
7. Finally, review all entered information for accuracy before signing at the bottom of the form and entering the date.

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