Insurance Form Plum Personal Plan

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Insurance form
Plum Personal Plan
You can use this form to change your death and total and permanent disablement
(TPD) insurance or salary continuance insurance (SCI) cover in the Plum Personal Plan.
Before you complete this form please read
the following:
• We recommend that you refer to your Product Disclosure
Once you have chosen the level of cover you would like to
apply for, please return your form to: Plum Super, Reply
Statement (PDS) for more information about your insurance
Paid 63 Melbourne Vic 8060.
cover and the associated premiums. Please note any
premiums payable will be deducted from your super account.
Need help?
• If you’re unsure about making a change to your insurance,
If you have any questions about your insurance or would like to
we recommend you seek licensed financial advice.
obtain general or personal financial advice, please contact us
• If you are applying to increase your cover you may need to
on 1300 55 7586 or write to us at Plum Super, GPO Box 63,
satisfy the insurer’s requirements before the insurer can
Melbourne VIC 3001.
determine whether your increase in cover can be granted.
What happens next?
• If you are applying to decrease or cancel your cover, please
We will contact you if the Insurer requires further medical or
note that it can not be reinstated without undergoing the
other information in support of your application. If accepted by
insurer’s health checks and other requirements. We will
the insurer we will confirm your new or changed cover details
reduce or stop deducting premiums from the date we receive
in writing to you.
your request.
STEP 1
Complete your personal details (please use BLOCK letters)
Member number
Surname (family name)
Given names
Title
Date of birth (DD/MM/YYYY)
Gender (please tick)
Mr
Mrs
Miss
Ms
Other
Male
Female
Residential address
Postcode
State
Business number
Home phone
Mobile
® Registered to BPAY Pty Ltd ABN 69 079 137 518
Trustee
Fund
GPO Box 63
Telephone 1300 55 7586
NULIS Nominees (Australia) Limited
MLC Super Fund
Melbourne VIC 3001
Fax 1300 99 7586
ABN 80 008 515 633
ABN 70 732 426 024
Web .au
AFSL 236465
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