Registration

Welcome

CareAssist VN is committed to protecting and respecting your privacy. Before we take any personal information from you, we will need your consent. If you are agreeable to provide us with any personal information, then please indicate this by selecting the check box.

I agree to providing CareAssist VN with my personal information.

Title:
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Surname:
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Mobile Number:
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Welcome

First Name:
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Email:
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ID Card Number:
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Income

Net Income:
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Employment Status:
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Pay Day:
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Congratulations! Your product options...

Care Assist VN

Product Options:
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I confirm having read and understood each of…
Terms & Conditions ?
Payment Method
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PLEASE NOTE: We are accepting your application based on the information you provided.

Card Number:
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Name on card:
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Expiry Date:
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CVV Code:
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Due Day:

 

Congratulations:

Dear [Title] [Initials] [Surname] we are pleased to confirm your request for your CareAssistVN service was successful. Please note that we have accepted your application based on the information stated below.

Login Details
Your Client Reference Number:
Your Pin Code:
 
Personal Information
Title:
First Name:
Surname:
Email:
Mobile Number:
ID Number:
We confirm that we have received the above Personal Information as submitted by you
 
Income & Expenses
Net Income:
Employment Status:
Pay Day:
We confirm that we have received the above information relating to your Disposable Income as submitted by you during the Income Assessment.
 
Product Options
Payment Method
We confirm that you selected the above mentioned Product Option.
 
Product Agreements
 
Card Information:
Card Association:
Name on card:
Card Number:
Expiry Date:
 
 
Connection Details
Processed
IP

         

Warning

Your IP address is not listed as from the country this product is sold.

But you may continue anyway. Press "OK" to proceed.