Agile Health Application Form


By Submitting this form, I declare that I understand the terms and conditions of Agile Assistance Membership and understand that Agile Assistance will provide me with a Printed Card, and a Membership Guide that explains the use of the card and related plans of Agile Assistance. I also understand that failure to comply with the Membership Guidelines of Agile Assistance may lead to cancellation of my membership and filing a fraudulent case of misuse against me with the relevant authorities in the Kingdom of Bahrain. If Credit Card Payment is selected, I authorize Agile Assistance to debit the Membership Fees from my credit card and for the purpose of auto-renewal of my membership on annual basis. In case I wish not to renew the membership, I must notify Agile Assistance of my intention in writing at least 30 days prior to the Expiry Date of the membership.

I acknowledge that there will be no refund at any time in case of cancellation or non-renewal of my membership by either party.