Insurance
Add dependant request template
Reviewed against the Cooperative Insurance Companies Control Law — Regulator: Insurance Authority — Last reviewed: 6 November 2026
This template follows the law of Saudi Arabia, not the law of the United States or any other country. Naming the regulator identifies the law that applies; it does not mean the regulator approved this template. This is a general template and does not replace advice on your own case.
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Add Dependant Request
Date: Date
To: Responsible Unit
Please add Dependant Name, my Relationship, born on Date of Birth, to my medical insurance, membership No. Membership Number, effective Effective Date. Attached: Documents.
Employee Name – Employee ID: Employee ID