Banking Details Change Due To Pharmacy Ownership Change

Please select the type of ownership applicable for the change of banking details and change of ownership of the pharmacy with MediKredit:

  • Download Pharmacy Registration form (to be completed by new owner)
  • Download the C2 Memorandum of agreement (to be completed by new owner)
  • Download the Authorisation Form (to be completed by previous and new owner)
  • Complete the required fields
  • Upload Pharmacy Registration form
  • Upload the C2 Memorandum of Agreement
  • Upload the Authorisation Form
  • Upload the bank letter/statement reflecting the pharmacy banking details (not older than 3 months)
  • Upload a copy of ID of new owner
  • Upload a copy of ID of previous owner

For all queries related to new pharmacies and change of details please contact +27 (0) 860-932-273 or e-mail [email protected].

Banking Details Change Due To Pharmacy Ownership Change

"*" indicates required fields

Name & Surname*

Upload Documents

Upload completed pharmacy registration form
Max. file size: 64 MB.
Upload your completed C2 Memorandum of Agreement form
Max. file size: 64 MB.
Upload your completed authorisation form
Max. file size: 64 MB.
Max. file size: 64 MB.
Max. file size: 64 MB.
Max. file size: 64 MB.
This field is for validation purposes and should be left unchanged.