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BIMCare Membership

Bimcare Membership (2)

Bimcare Membership (1)

Application Form

BIMCare Membership

Given Name*
Surname*
Email*
Nationality*
Date of Birth*
Sex *
Phone
Mobile
Card Type*
Address

Additional Family Member

Additional Family Member 1
Name
Date of Birth
Sex
Additional Family Member 2
Name
Date of Birth
Sex
upload scanned copy KTP/KITAS/KITAP*
"BIMC Privilege Club is available upon presentation of KTP/KITAS/KITAP or retirement visa"

Get in Touch

We value your inquiry and interest towards our services in BIMC Hospital, therefore please complete this following form and we will respond to you within maximum 48 hours of receiving your request.

BIMC Nusa Dua

Kawasan ITDC Blok D
Nusa Dua 80363, Bali, Indonesia
Tel:+62 361 3000911
Email:admin.nd@bimcbali.com
find us :

BIMC Kuta

Jl. Bypass Ngurah Rai No 100X
Kuta 80361, Bali, Indonesia
Tel:+62 361 761263
Email:admin@bimcbali.com
find us :

BIMC Ubud

Jl Raya Sanggingan No 21, Kedewatan,
Ubud - Gianyar 80561, Bali, Indonesia
Tel:+62 361 2091030
Email:admin.ubud@bimcbali.com
find us :

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