Insurance Form Plum Personal Plan (Page 2 of 3) in pdf

Insurance Form Plum Personal Plan Page 2

STEP 2

Select your level of death cover or death and TPD cover

Tick one of the boxes below to apply for or change your death cover or death and TPD cover

I would like to apply for or increase my:

Death and TPD cover

Death cover only

(total amount of cover required)

I would like to decrease my:

Death and TPD cover

Death cover only

TPD cover only

(total amount of cover required)

Please note that any TPD cover you have cannot exceed the amount of death cover that remains within the Plan.

I would like to cancel my:

Death and TPD cover

Death cover only

TPD cover only

If you have selected option A above, you will be required to provide evidence of health prior to being accepted for any cover.

Please refer to Step 4 for further details.

STEP 3

Apply for or change your level of SCI cover or change your benefit and/or waiting period

Tick one of the boxes below to apply for or change your level of SCI cover:

I would like to make the following change to my SCI cover:

SCI cover provides a

monthly benefit of up

New cover

Increase cover

Decrease cover

Cancel cover

to 75% of your salary

p.a. (amount of cover required)

I would like to nominate or change my SCI waiting and benefit period:

30 days/2 years

60 days/2 years

90 days/2 years

30 days/5 years

60 days/5 years

90 days/5 years

180 days/5 years

30 days/to age 65

60 days/to age 65

90 days/to age 65

180 days/to age 65

Occupation declaration

You may be eligible for discounted premium rates if your occupation type is ‘White collar’.

Please tick the box if each of the points below is applicable to you:

• I spend at least 80% of my working hours in an office;

• My occupation includes minimal manual duties or very light skilled duties; and

• I am not exposed to any unusual occupational hazards.

STEP 4

Provide evidence of health

When applying for or increasing your cover you will also need to complete and sign a personal statement. The personal statement is

available by logging on to .au using your PIN number, or by contacting us on 1300 55 7586.

Page 2 of 3

Insurance Form Plum Personal Plan Page 2

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