AlSharq Healthcare

Full Name

Valid UAE Mobile Number

Email

Choose Your Location

Please choose your diver category
Commercial Diver Recreational Diver Other

Enter Diver Category

Choose Dive Centre / Club

Enter Diving Centre Name

Nationality

Date of Birth

Gender
Male Female

Do you have a Medical Fitness Certificate?
Yes No

Medical Fitness Expiry Date

Do you have DAN (Divers Alert Network) Insurance?
Yes No

Do you have Medical Insurance?
Yes No

Select Your Insurance Company

Enter Insurance Company Name