Close your eyes and think for a second. What would happen to your family if you or your partner dies? Can they pay the mortgage? Who will look after the kids if you or your partner have to work?

Life insurance is a critical building block in your financial situation. It can be used to pay off your home, pay for your children’s education or care should you or your partner die. It can happen to you!

TPD: Total & Permanent Disability Insurance – pays you a lump sum when you suffer a TPD or loss of independence. TPD can be applied for as part of your Life Insurance Cover or as a Stand Alone insurance.

Trauma: Pays a lump sum if you contract a specified critical condition as defined in the policy document (ie. Cancer, Stroke, Heart Attack). Trauma cover can be applied for as part of your Life Insurance Cover or as a Stand Alone insurance.

* required fields

   
 

Personal Details

Salutation

Smoker?**

First Name*

Surname

Date of Birth

Gender:

Email Address*

Phone

Street Address:

Suburb:

State:

Postcode

Occupation

Or describe Occupation:

 

** select smoker if you have smoked in the last 12 months
 

Lump Sum Cover

Please complete the following, if you only require one lot of quotes fill out the sections under quote 1, if

you would like quotes for two different amounts complete quote 1 and quote 2.

 

Quote 1

Quote 2

Term Life Cover lump sum on death

$

$

TPD Cover lump sum for permanent disablement

$

$

Trauma Cover lump sum on medical events

 $ $
 

Referred By

(only complete if you have been referred by an existing client)

Comments