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Form analysis
1 forms found in the DOM

POST /Home/Subscribe

<form action="/Home/Subscribe" data-ajax="true" data-ajax-mode="replace" data-ajax-success="subscribeOnSuccess" data-ajax-update="#subscribeResult" id="form0" method="post">
  <div class="validation-summary-valid" data-valmsg-summary="true">
    <ul>
      <li style="display:none"></li>
    </ul>
  </div>
  <div class="form-horizontal ">
    <div class="control-group">
      <label class="control-label">Beneficiary Type</label>
      <div class="controls">
        <select class="input-medium" data-val="true" data-val-required="Beneficiary Type is required" id="PersonType" name="PersonType">
          <option value="">Please select --</option>
          <option value="Employer">Employer</option>
          <option value="UAE National">UAE National</option>
          <option value="Resident">Resident</option>
          <option value="Visitor">Visitor</option>
          <option value="Sponsor">Sponsor</option>
        </select>
      </div>
    </div>
    <div class="control-group hidden" data-for="Employer">
      <label class="control-label">Company Name<span class="mandatory">*</span></label>
      <div class="controls">
        <input class="input-medium" id="CompanyName" name="CompanyName" type="text" value="">
      </div>
    </div>
    <div class="control-group hidden" data-for="Employer">
      <label class="control-label">Number of Employees<span class="mandatory">*</span></label>
      <div class="controls">
        <input class="input-medium" data-val="true" data-val-number="The field TotalEmployees must be a number." id="TotalEmployees" name="TotalEmployees" type="text" value="">
      </div>
    </div>
    <div class="control-group hidden" data-for="Employer">
      <label class="control-label">Zoning Authority<span class="mandatory">*</span></label>
      <div class="controls">
        <input class="input-medium" id="ZoningAuthority" name="ZoningAuthority" type="text" value="">
      </div>
    </div>
    <div class="control-group hidden" data-for="Employer">
      <label class="control-label">Trade License<span class="mandatory">*</span></label>
      <div class="controls">
        <input class="input-medium" id="TradeLicense" name="TradeLicense" type="text" value="">
      </div>
    </div>
    <div class="control-group">
      <label class="control-label">Name<span class="mandatory">*</span></label>
      <div class="controls">
        <input class="input-medium" data-val="true" data-val-required="The Name field is required." id="Name" name="Name" type="text" value="">
      </div>
    </div>
    <div class="control-group">
      <label class="control-label">Email<span class="mandatory">*</span></label>
      <div class="controls">
        <input class="input-medium" data-val="true" data-val-required="The Email field is required." id="Email" name="Email" type="email" value="">
      </div>
    </div>
    <div class="control-group hidden" data-for="Employer">
      <label class="control-label">Designation<span class="mandatory">*</span></label>
      <div class="controls">
        <input class="input-medium" id="Designation" name="Designation" type="text" value="">
      </div>
    </div>
    <div class="control-group">
      <label class="control-label">Phone</label>
      <div class="controls">
        <input class="input-medium" id="Phone" name="Phone" type="text" value="">
      </div>
    </div>
    <div class="control-group hidden" data-for="Employer">
      <label class="control-label">Company Address</label>
      <div class="controls">
        <input class="input-medium" id="CompanyAddress" name="CompanyAddress" type="text" value="">
      </div>
    </div>
    <div class="control-group">
      <label class="control-label"></label>
      <div class="controls">
        <input type="submit" value="Subscribe" class="btn btn-success" id="btnSubscribe">
      </div>
    </div>
  </div>
</form>

Text Content

ISAHD

العربية


 * Home
 * About ISAHD
 * What does it mean to ME
 * Our Services
 * Contact us


GET INSURED AND STAY HEALTHY..

HOW TO GET HEALTH INSURANCE IN DUBAI?    PERMITTED COMPANIES PARTICIPATING
INSURERS ISAHD COMMUNITY MARKET PLACE

 * Law & Regulations
 * Permitted Companies
 * In the Media
 * Forms & Guides
 * Reports

Have a question about ISAHD? How does it impact you? Check our frequently asked
questions and if still have an issue send us your question through our contract
form.

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Check out ISAHD initiatives that shall provide the people of Dubai with smart
solutions in the coming 2 years to improve access and quality of healthcare.

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Visit the Dubai Health Authority official website

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Watch a movie, introducing ISAHD for public and explaining how to access
healthcare.

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View details about eClaimLink portal serving healthcare providers, payers and
Authority.


Important links

 * Executive Council Resolution No. 7 of 2016

 * 

Beneficiary Type
Please select -- Employer UAE National Resident Visitor Sponsor
Company Name*

Number of Employees*

Zoning Authority*

Trade License*

Name*

Email*

Designation*

Phone

Company Address


Dubai Health Authority. Copyright © 2014 . All Rights Reserved.
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