Submit a Foreign Medical Certificate or Foreign Hospital Discharge Letter

Sickness Benefit

Applicant’s Details

Identity Card Number / Social Security Number

Nationality

Name

Surname

Contact Number

Date of Birth

Foreign Medical Certificate Details for Treatment / Emergency Abroad

Examining Doctor’s Name and Surname

Date of issue of Certificate / Discharge Letter

Country of Treatment

Hospital Name of Treatment

Date from Treatment Abroad

Date to Treatment Abroad

File Upload Foreign Medical Certificate / Foreign Hospital Discharge Letter

Maximum file size: 5MB

Note: Certificate/Letter should be in English or with an English translation attached

Bank Account Details

Benefit should be deposited in a Savings or Current Account, but not in a Loan Account. The indicated account must be in the name of the beneficiary. The bank account details provided will also be used for all benefits that you may be currently receiving.

Bank Name

BIC

For foreign banks

IBAN

Enter a Maltese Mobile Number for an SMS notification regarding payment

Insert email address here to receive a copy of your application.

I confirm that the attached certificate is a true copy and information submitted is correct and true

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