Payment Options Form | CPD | Focus On Health

Select your FoH membership No from the drop down below to view your balance and pay OR complete this form to make alternative payment arrangements.

Ignore if you have a debit order with us. Should you not find your membership no, your account was settled or paid by an employer.

Focus on Health Membership Number*

Balance

R0.00

Please provide us with your FoH No / HPCSA No to receive a notification of your account balance*

I would like to pay via*

When did you open your account at your Current Bank?*

Bank Name*

Type of Account*

Account Number*

Branch Code*

Branch Name*

Account Holders Name*

Preferred Debit Order Date*

Abbreviated name as it will appear on your bank statement*

ID Number*

Banking Details
Bank Name: ABSA
Account Type: Cheque
Account Nr: 405 843 7431
Branch Code: 632 005
Ref No: HPCSA no

Payment Date*

Upload proof of payment

Max. file size: 64 MB.

Card Description*

Name on Card*

Card Number*

Expiration Month*

Expiration Year*

Straight / Budget*

Cvv*

Budget*

Email*

Make arrangements*

Payment Date*