Apply for insurance over the phone

Use this form if you would like us to call you back to apply for insurance over the phone. Please note that callbacks can only be requested at least two business days after the form has been submitted.

For help choosing your level of cover, or to see the costs of your cover, use the Insurance cover and cost calculator.

Registered for online access?

You can now apply to update your insurance online.

Your Full Name*:

Your Member ID*:

Your Phone Number:

Your Email*:

What insurance are you applying for*? Tick as many as apply.

Death

Total and Permanent Disablement (TPD)

Income Protection (IP)

What waiting period would you like on your IP (if applicable)?

30 days

60 days

90 days

If applying for Death insurance, how much cover are you applying for (minimum is 1,000 dollars)?

If applying for TPD insurance, how much cover are you applying for (minimum is 1,000 dollars)?

If applying for IP cover, how much are you applying for per month (minimum 1,000 dollars)?

Choose what day you would like to be called (Monday to Friday)*:

What time would you like to be called*?

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* Required field.