AriseCare – Akwa Ibom State Association of Nigeria(TM) (USA), Inc. (AKISAN USA(TM))

Welcome to the AKS ARISECARE AKISAN Group Plan Enrollment page, where you can ensure your loved ones in Akwa Ibom State receive the healthcare they deserve. By filling out this form, you are taking a significant step toward securing affordable healthcare coverage under the AKS ARISECARE Health Insurance Scheme.

Why Enroll? Your contribution of $20 will provide health insurance for your family members back home, giving them access to quality healthcare services. Together, we can make a difference in the health and well-being of our community in Akwa Ibom State. Your support helps us advance healthcare in our communities. Thank you for taking this step to safeguard your family’s health.

ARISECare Donation Form

Fill up this form to add the beneficiary to The ARISE Care Health Insurance Scheme.

Beneficiary Data

Please provide details about the Beneficiary

Beneficiary First Name

Beneficiary Last Name

Beneficiary Phone Number

Beneficiary Date of Birth

Beneficiary Category

Other Categories of Beneficiary

Beneficiary NIN

Sex of Beneficiary

Marital Status of Beneficiary

Beneficiary L.G.A

Beneficiary Home Address

Beneficiary Next of Kin Details

Please provide details about the Beneficiary's Next of Kin

Beneficiary Next of Kin

Same as the address above

Same address

Beneficiary Next of Kin Address

Don't fill if you have the same address

City

State

Country

Phone No. of Next Of Kin

Beneficiary Relationship to Next Of Kin

Donor Details

Please provide details about yourself.

Donor's First Name

Donor's Last Name

Donor's Phone/Mobile

Donor's AKISAN USA Chapter

Donor's Email

1 Year payment for AKS ARISECare Health Insurance Scheme

$20.00

Pay with Card (Stripe)

Stripe test mode activated

AKISAN USA, Inc. does not discriminate on the basis of sex, age, color, gender, intellectual disability, or learning disability. AKISAN USA, Inc. does not condone acts of discrimination or harassment. Reports of discrimination or harassment should be directed to the local public authorities.

Useful links

AKWA IBOM HOUSE

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Address: 5120 Old Bill Cook Rd, Atlanta, GA 30349, United States

Akwa Ibom State Association of Nigeria, (USA) Inc. (AKISAN USA)
P. O. Box 21
Dacula, GA 30019

Mailing box

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