Diaspora Enrollment Form

Register your loved ones for Diaspora Family Care.

Use this form to begin structured healthcare cover for parents, relatives or dependants in Nigeria.

Before you begin

You will need the sponsor’s contact details, beneficiary information, location, age, preferred provider area and consent pathway. For adult beneficiaries, consent may be required before health information can be shared with a sponsor.

How enrolment works

Submit sponsor details. Submit beneficiary details. Choose plan pathway. Confirm consent and documentation. Receive quote and payment guidance. Activate member records after approval.

What sponsors should understand

Diaspora sponsorship supports healthcare cover. It does not automatically give the sponsor unrestricted access to private medical information. Consent, privacy and plan rules apply.

After enrolment

The beneficiary receives member access details, provider guidance and support contacts. The sponsor receives plan and renewal information as permitted.

Diaspora enrolment flow

Use a multi-step form: sponsor details, beneficiary details, location and provider preference, health needs disclosure, consent pathway, quote request, payment guidance and activation.

Form

Complete the form below and LifeCome HMO will route your request to the appropriate team.

Sponsor Full name

Country of residence

Email Address

Phone Number

Beneficiary full name

Beneficiary relationship

Beneficiary date of birth/age

Beneficiary phone

Beneficiary address/state/city

Preferred provider area

Known health needs

Consent pathway

Payment preference

Message

By submitting this form, you confirm that the information provided is accurate and that LifeCome HMO may contact you about this request, subject to its Privacy Policy.