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FORM FOR YOUR 1st APPLICATION REGISTRATION

Steps for downloading and sending applications forms

1) Download PDF file
2) Fill in the fields
3) Save to your computer
4) Send the forms – click on : lgi.medical@gaz-industriels.com and attach the PDF files.
5) Please attach: a) NIC, b) Proof of Address of Applicant, Patient and Surety and, c) Doctor's Prescription

The medical department will contact you within 2 working days once your application is received.
1st delivery and installation are free – our Homecare Officer will advise you on the medical equipment use.
Payment by bank transfer, Juice or cash upon delivery.