Initial Approval for Health Insurance Revenue Cycle Managment Company

CR Number *

Company's Name - En *

Company's Name - Ar *

Legal Type *

Establishment Date

Postal Address *

Phone (+968) *

Fax (+968)*

Region *

Oman Wilayat *

Email *

Website Link *

Location on Google Map

Street - Arabic *

Street - English *

#	Document Type	Upload File
1	Copy of the constitutive contract *
2	Non-conviction certificate for the founders, members of the board of directors and senior executive management (general manager) *
3	Copy of the articles of association *
4	Copy of the commercial registration *
5	Copy of the membership certificate of Oman Chamber of Commerce and Industry *

ID Card Number *

Password *

Confirm Password *

Phone * (+968)

Email *

First Name - Ar *

Last Name - Ar *

First Name - En *

Last Name - En *

Declaration

I, the applicant hereby declare the following:

I read the licensing requirements to carry out the health insurance revenue cycle managment activity and pledge to comply therewith.
I shall provide all the statements or information the FSA requires.
That all the statements and information in this application are correct and I shall be liable for any consequences if the contrary is proven.

Agree