Life Insurance

	You	Your Partner (Optional)
Date of birth
Sex	Male Female	Male Female
Have you smoked within the last 12 months?	Yes No	Yes No
Any current or previous illnesses? E.g. Back or Neck Injuries Diabetes Heart Disease Cancer Mental Illness Depression	Yes No	Yes No
Your Illness Details Please provide full details including when the illness occurred, what treatment was received and if the illness is still ongoing.
Partner Illness Details Please provide full details including when the illness occurred, what treatment was received and if the illness is still ongoing.
Current height
Current weight

In the event of your pre-mature death would you want to be able to pay off the mortgage / debts, pay for funeral costs and let your family maintain their current standard of living with your childrens education catered for?

Life insurance provides a lump sum payment to protect your loved ones should you pass away or become terminally ill.

TPD Insurance

If you became totally and permanently disabled would you want to be able to pay off the mortgage, pay for home modifications, pay for the cost of a carer and maintain your current standard of living?

TPD Insurance will pay a lump sum payment if you are totally and permanently disabled and unable to ever return to work.

Trauma Insurance

Would you want to be able to pay off the mortgage, take time off work or have the best possible treatment if you were to fall critically ill or suffer a trauma event?

Trauma Insurance will pay a lump sum payment on diagnosis one of the listed trauma events. Heart Attack, Stroke, and Cancer are just a few to mention.

Income Protection

Would you like to ensure you could continue to pay your household bills if you can't work due to an accident, illness or disability?

Income protection will protect up to 75% of your gross income paid ongoing on a monthly basis (Tax Deductible)

Living Expenses

Would you like $3000 per month to ensure you could pay the day-to-day living costs or help with either in-home carers or a long term care facility and replace the costs of things such as child care and housekeeping costs?

Living expenses insurance provides a monthly payment to the life insured if they were to become significantly disabled.

Business Expenses

Would you like to ensure you could continue to pay business expenses if you can't work due to accident, illness or disability?

Business Expenses insurance will protect up to 100% of your fixed business overheads on a monthly basis for up to 1 year (Tax Deductible)

	You	Your Partner (Optional)
First Name
Last Name
Mobile
Daytime Phone
Best Contact Time
Email Address
Postcode

	You	Your Partner (Optional)
What is your employment status?
Occupation
Annual salary (inc super)
Main reason for this cover?

= Further Explanation	You	Your Partner (Optional)
Life Cover	Life Cover People typically cover existing debts, funeral expenses (about $10K) and ongoing family expenses (annual expenses for 5 - 15 years) (Not sure how much to enter?)
TPD Insurance	TPD Insurance People typically cover existing debts and the annual salary until retirement (Not sure how much to enter?)
Occupation Definition	TPD Insurance - Occupation Definition Any If you are totally and permantly disabled and unable to perform 'Any' Occupation which you are suitably qualified to do via training, education or experience. Own If you are totally and permanently disabled and unable to perform 'Own' Occupation you will be paid the claim, this definition is slightly more expensive but is much easier to claim on than the alternative. Superfunds do not have this definition. Example Case You're a surgeon but lose your hand in a car accident. With an 'Own' occupation definition you would be paid the claim because you would no longer be able to perform surgery. However, with an 'Any' definition you would not be able to claim as you would be qualified to perform other occupations.
Trauma Insurance	Trauma Insurance People typically cover existing debts, medical costs (around $200K for major illness) and ongoing annual expenses (Not sure how much to enter?)
Monthly Business Expenses	Business Expenses Enter the amount you would require per month
Income Protection (per month)	Income Protection Enter the amount you would require per month
Type of Policy	Income Protection - Policy Type Agreed Value Policy You prove what you are earning at the time you apply for the insurance. From then on any drop or inconsistency in income will not affect any total disability claim you may have. Hence this type of policy can give you certainty at time of claim. Generally surperfunds don't offer this type of policy. Indemnity Policy With this type of policy there is no requirement to prove your income at the time you take out the policy. However the monthly benefit in an indemnity policy is restricted to the amount you are insured for or 75% of your income in the 12 months prior to claim, whichever is the less Example If your income was $100,000 and you were insured for $6,250 per month. You are out of work and it takes 6 months to find new work then you become ill or injured. If you had an agreed value policy the insurer would pay you the monthly benefit of $6250. If you had the indemnity policy the insurer would only pay $3,125 because you only earned $50,000 in the 12 months prior.
Waiting Period	Income Protection - Waiting Period The waiting period is like the excess on your car insurance, it doesn't matter how long the policy has been in place for it is the amount of days you will need to wait from time of illness before benefits start accruing. Your options are 14, 30, 60 and 90 days or 6, 12 and 24 months. Income protection should be used to protect against short term and long term illness and injuries, therefore try and seleect a waiting period that matches your financial situation. Commonly people choose a 30 day wait. Example You have a 30 day waiting period but are sick for 29 days, you would not receive any benefits. However, if you were sick or injured for 90 days then you would receive 60 days worth of benefits.
Benefit Period	Income Protection - Benefit Period The benefit period is the maximum period of time a claim will be paid after the waiting period had ended. Choices are normally 2 years, 5 years or through to age 65 or age 70. Income protection should be used to protect against short term and long term illness and injuries, therefore try and select a benefit period that matches your financial situation. Commonly people have a benefit to age 65.
Monthly Living Expenses	Living Expenses Enter the amount you would require per month
Waiting Period
Benefit Period
Insurance Type	Insurance Type 'Stepped' premiums increase each year as you get older; the amount they increase each year will depend on age (usually between 10-15% each year). This means that as you get older the insurance premiums will rise significantly. 'Level' premiums are set at the age of entry and remain relatively consistent for the same sum insured amount. 'Level' premiums means it is unlikely to have large jumps in premium so you are less likely to lapse your policy due to premium increases, just when you are likely to need it the most. 'Level' premiums will be he higher at first, but over the medium to long term they are siginificantly cheaper.

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