Insurance — New member options form

New members can use this form to:

• opt in to and increase their Default Cover within 120 days of their welcome letter
• increase their Default Cover within 120 days of the date of their insurance commencement letter.

Personal details

Your insurance category

Please make sure you read and answer the following questions carefully — your responses will impact your insurance category, sum insured and premium amounts.

Election to opt in to Default Cover

Please complete within 120 days of receiving your welcome letter if you wish to receive Default Cover. You will also need to complete the Short Form Personal Statement in Section 7.

Request to increase Default Cover for Life and TPD

Request to increase Default Cover for Income Protection (IP)

Please select either of these options:

All your default IP cover will be converted to Fixed Cover if your requested increase is approved. The increased amount together with your existing cover amount, cannot exceed the amount of $120,000 per annum (referred to as the Conditional Acceptance Limit).

Inactive account — election to maintain your cover

If you have insurance cover in your NGS account and your account becomes Inactive for a continuous period of 16 months, your cover will be cancelled unless you have elected to keep it. You must make an election before your account becomes Inactive. Generally, an account is Inactive where we have not received a contribution or rollover for a period of 16 continuous months.

To maintain your insurance cover and prevent it from being cancelled, simply complete this section.

Short form personal statement

If you answer 'False' to any of the statements from 1-5 below or 'True' to statement 6, you are not eligible to opt in to Default Cover or increase your Default Cover. If you believe your condition may change, you can wait until you are eligible (your account balance has reached $6,000 and you are at least age 25). If you still wish to apply for insurance cover (or additional cover), you will need to complete the Increase cover form which includes a Full Personal Statement.

I confirm the following: