Electronic Funds Transfer (Eft) Authority Form

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Electronic Funds Transfer
(EFT) Authority Form
Salary Continuance Insurance (SCI)/
Income Protection (IP)
This form is to be completed by the Member. Should your claim be admitted by AIA Australia, we will pay your
SCI/IP benefits directly into your nominated bank account. AIA Australia will keep your account details confidential.
We will make reasonable efforts to ensure that the information is secure and is only disclosed to the parties for the
main purpose for which the information was collected. For information on AIA Australia Privacy Statement,
please see the Privacy Statement that accompanied your Claim Form.
Member Name
Fund Member No.
Bank Name
Branch Name
—
BSB Number
Account Number
Account Name
Signed
/
/
Dated
Please return this form with your initial claim documentation.
GC1081
AIAGR06482 – 10/11
AIA Australia Limited (ABN 79 004 837 861 AFSL 230043)
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