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Mobile Panic Button Application

  • Price: R59.50
  • User/s

  • 1. User Name2. User Name3. User Name4. User Name5. User Name 
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  • 1. Contact Numbers2. Contact Numbers3. Contact Numbers4. Contact Numbers5. Contact Numbers 
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  • 1. Medication Allergies2. Medication Allergies3. Medication Allergies4. Medication Allergies5. Medication Allergies 
    Add a new row
  • 1. Blood Type2. Blood Type3. Blood Type4. Blood Type5. Blood Type 
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  • Password

  • This is a password used when our Control Room contacts you once we have received a panic signal from the mobile panic button app to verify that we are speaking to the account holder and that everything is safe and secure.

  • Medical Aid Details

  • Debit Order Banking Details

  • If the amount to be paid or payment dates change HALT Group will notify you in writing in advance of your account being debited or as otherwise agreed. If HALT Group or your bank makes an error, you are guaranteed a full and immediate refund from HALT Group of the amount paid.

  • R0.00
  • I hereby instruct and authorize HALT Group to draw against my bank account the payment required in terms of my service agreement on the 1st day of each month and continuing for the duration of this service agreement. I undertake against the said bank that I shall regard receipt and acknowledgement by HALT Group of this request, as receipt and acknowledgement by the bank.
  • Submit Agreement

  • Please ensure that all the details contained in the electronic service agreement are correct. You should only press the submit button if you are prepared and able to keep it's legal terms and conditions.
  • This field is for validation purposes and should be left unchanged.