Application form for an Entitlement Card
issued in terms of the Health Care
Convention between the Government of the
Republic of Malta and the Government of the
United Kingdom of Great Britain and
Northern Ireland
Fill in using BLOCK LETTERS
Persons who are not yet in possession of a residence permit may still apply for this scheme but will be
covered on a provisional basis.
Declaration:
I hereby declare that I reside in Malta or in Gozo and have consented to my personal details being
disclosed. All the information given on this form is correct and complete to the best of my knowledge.
I undertake to inform immediately the Entitlement Unit of any changes in my residence status. I agree
to this scheme’s terms and conditions.
I declare that I do not work or receive a state pension:
I would like to receive notification/s through: Email
SMS
Signature of Applicant Date
Completed application forms are considered and processed as confidential documents.
The unit retains the right to ask for further information to ascertain entitlement. All data is collected and processed in accordance with the General Data
Protection Regulation (EU) 2016/679 (GDPR) and the Data Protection Act (Cap 586), the said Ordinance, other subsidiary legislation and the
Directorate’s Data Protection Policy.
Ground Floor, Ex-Outpatient Block,
St. Luke’s Hospital, G’Mangia Hill, G’Mangia, PTA 1010
Tel: 2595 2400 Email: entitlement[email protected]
http://www.ehic.gov.mt
FOR OFFICE USE ONLY
Above
information authenticated and verified
by
:
__________________
__________________
Signature
Rubber Stamp
@
Email
Terms and Conditions:
The RHA Entitlement Card issued will entitle holders to healthcare services in local public
healthcare institutions on in-patient and out-patient basis as well as other specialist
services provided for Maltese nationals.
RHA Entitlement Card holders will not be entitled to treatment abroad (including the UK),
the European Health Insurance Card (EHIC) or long-term care and other things and
services provided for under the Social Security Act and other legislation.
The RHA Entitlement Card is valid for two (2) years:
Applicants with pending residence permit applications and holding an official
acknowledgement letter are issued with a Provisional Certificate valid for six
(6) months.
Instructions:
A separate application must be submitted for each family member.
Fill in and sign the application form. Please ensure all filled-in information is correct.
Applications may be submitted online/emailed at [email protected], handed in
personally or sent by post to the Entitlement Unit, Ground Floor, Ex-Outpatient Block, St.
Luke’s Hospital, G’Mangia Hill, G’Mangia, PTA 1010.
For further information or in case of difficulty, please consult our website:
http://www.ehic.gov.mt, call us on 2595 2400 or visit our office during the opening times
hereunder.
Opening hours: Monday to Friday 08:00 – 13:00
You need to present your MT residency permit (if available) and a valid UK passport.
V1.
