Changing your insurance arrangements

Transcription

1 AMP Contact Centre (131 AMP) Changing your insurance arrangements Use this form to cancel, decrease, add or increase insurance for a Flexible Lifetime Super account or an AMP Flexible Super Super account with Super Protection insurance or Flexible Protection insurance. Flexible Lifetime Super accounts: Ensure the amounts entered include any employer-based InstantCover and/or Basic Cover applicable to your account. For more information refer to the Product Disclosure Statement or speak to your employer or financial planner. Please print in CAPITAL LETTERS and place a cross in any applicable boxes 1. Personal details Account number Product type 2. Cancelling or decreasing insurance Death cover/extra Death Benefit (EDB) Title of birth Surname Given name(s) Residential address (a PO Box is not acceptable) Suburb State Postcode Contact phone number Mobile number ( ) address Address for communications Please cross if same as residential address. Address Suburb State Postcode Permanent incapacity cover/total & Permanent Disablement (TPD) Benefit Temporary incapacity cover/temporary Salary Continuance (TSC) Benefit per month Cancel the Super Guarantee (SG) option/superannuation Contribution Option (SCO) Decrease my nominated SG/SCO percentage % Other benefit options Cancel my Future business insurability/business Safeguard Benefit Cancel the Waiver of Premium option/waiver Benefit AMP Superannuation Limited (ASL) ABN , AFSL No Registered trademark of AMP Life Limited ABN of 5

2 3. Adding or increasing insurance Note: Complete a separate Personal statement if you are increasing or adding an insurance benefit and/or indexing for inflation. Habits and occupation a. Have you smoked tobacco (or any other substance) or used nicotine replacement products in the last 12 months? No please advise the type of substance(s) used: Quantity per: b. What is your current occupation? day week month Death cover/edb and Permanent incapacity cover/ TPD Benefit Add/increase the Death cover/edb (new amount after change) Add/increase the Permanent incapacity/tpd Benefit (new amount after change) e. Occupation group 4A 2M 3B 3A A 2B 2A 4B 1B Other benefit options Add Future business insurability/business Safeguard Benefit Add Waiver of Premium option/waiver Benefit Add the CPI/Indexation feature 4. Transfers or conversions Note: If you are transferring to an existing AMP (insurance only superannuation) plan and want to claim a tax deduction for contributions made to that plan, please call us before returning this form. We will send you a Notice of intent to claim a tax deduction form to complete and return. a. Are you eligible for a transfer of insurance benefits from another AMP plan? Note: To find out if you are eligible to transfer your insurance benefits, please call us on No go to section 5. go to question 4b. b. Are you applying for an increase in cover or adding any new benefits? No c. AMP policy/plan number you are transferring from Temporary incapacity cover/tsc Benefit a. Add/increase my Temporary incapacity cover/tsc Benefit to (new amount after change): per month Total maximum benefit (including the Super Guarantee (SG) option/superannuation Contribution Option (SCO), if applicable) b. Super Guarantee (SG) option/superannuation Contribution Option (SCO) Remove Add Increase % Nominated SG/SCO percentage The percentage I have nominated is not more than the percentage that is currently being contributed to my complying super fund. c. Waiting period 1 4 weeks 8 weeks 13 weeks 26 weeks 104 weeks 30 days 60 days 90 days 180 days 720 days d. Benefit period 1 2 years 5 years To age 65 d. Sum insured to be transferred e. Conversion of CP/R units Plan number Number of units to convert Authority Sum insured to be transferred I/We as plan owner(s) of the plan above (or insured person(s) of a superannuation plan), request that this plan be altered as indicated, effective from when the insurance benefits have been added. Signature of owner 1 (or insured person if existing policy is superannuation) Signature of owner 2 (or insured person if existing policy is superannuation) 1 Please refer to the current Product Disclosure Statement for details of available waiting periods and benefit periods. 2 of 5

3 5. Existing insurance details Do you have in force, or are you applying for, any personal insurance with AMP or other insurer (other than this application)? No go to section 6. please provide full details in the table below of: any policies in force with AMP any policies in force with other insurers any policies that you are applying for with other insurers. Important: Your application will be considered on the understanding that if you intend to cancel any existing cover, that you will do so on acceptance of this application. Failure to do so may render invalid a claim on your AMP plan. If this application is to replace a current AMP plan, the plan to be replaced will cease and a new plan will start. Do not include values of cover from this application in your responses below. Name of insurer Life cover () TPD cover () Trauma cover () Monthly disability (income) cover () and disability type 1 Cancel cover? Policy number AMP Life Limited 1 Disability types: TSC = Temporary Salary Continuance/Temporary incapacity, IP = Income Protection, BOI = Business Overheads Insurance 6. Business Safeguard Benefit/Future business insurability Are you exercising your existing Business Safeguard Benefit/Future business insurability to increase cover? Please refer to the latest PDS for conditions and eligibility criteria. No go to section 7. enter new amounts below (after change) Death cover/extra Death Benefit Permanent incapacity cover/total and Permanent Disablement Benefit Note: Please attach the appropriate financial evidence to this form (speak to your financial planner or AMP for the requirements). 3 of 5

4 7. Agreement and declaration If you are under age 18, you should speak to your parent or guardian about your application for additional insurance cover before signing this form, and understand that by signing this form you give up any claims against the trustee in relation to the additional insurance cover in this form arising out of or in connection with your being a minor. 1. I confirm that I have given and have read, or have had the opportunity to read, the latest Flexible Lifetime Super or AMP Flexible Super Product Disclosure Statement (PDS) as well as any supplements or updates to that PDS. I am aware that there is additional insurance information relating to the PDS available in the AMP Flexible Super Fact Sheets. The Fact Sheets include information on when AMP and the trustee will pay the benefits. 2. To the best of my knowledge, information and belief, the information provided in this application and in any other documents I provide for the purpose of this application is accurate and complete even if the information has been written by someone else. 3. By completing and signing this application form, (and Personal statement, if applicable), I: have read the Duty of Disclosure in the Personal statement and understand that my duty of disclosure continues after completion of this form until the time AMP advises me in writing that it has accepted the risk will advise AMP of any change to my health or occupation or any other matters that could be relevant to AMP, prior to any insurance benefit being increased or added to my plan authorise any doctor, hospital or other health service provider that I have or may attend to release details of my personal medical history, including referrals to or treatment by other practitioners, to AMP. I have been advised by AMP of the ways this information may be used, and to whom it may be disclosed, and approve those purposes consent to AMP Life and/or their health screening provider to speak to a third party for the sole purpose of arranging a health screening appointment. This third party may include a spouse, family member, personal assistant, financial planner or other relevant party. 4. If I am transferring insurance cover from another AMP Life (Existing plan): a. I understand that: cover in the Existing plan ends when the Flexible Lifetime Super, AMP Flexible Super Super (Super Protection) or AMP Flexible Super Super (Flexible Protection) insurance benefit is added to my plan my Flexible Lifetime Super, AMP Flexible Super Super (Super Protection) or AMP Flexible Super Super (Flexible Protection) insured benefits are provided on the basis that the statements made by me are accurate and complete, and any special conditions applying to the Existing plan will continue under the new plan. b. I confirm that I complied with my Duty of Disclosure, when applying for the Existing plan. 5. I understand that I cannot receive a benefit paid under Terminal Illness Benefit, Terminal medical condition cover, Total & Permanent Disablement Benefit or Permanent incapacity cover (including benefits paid under the definition for professionals, senior managers and home duties) in cash or to commence a pension unless I am eligible to access my super benefit. 6. I have read the Privacy Information in the PDS and agree to the various uses and exchanges of my personal information and acknowledge my right to access personal information held about me by the AMP group. Signature of member 4 of 5

5 8. Financial planner and office use only Note: This section is to be completed by your financial planner. If splitting fees it applies to initial risk commission only. Financial planner name Planner number Phone number address Initial income split (total 100%) Servicing planner ( one only) Commission details for Flexible Lifetime Super or AMP Flexible Super Super (Flexible Protection) Please indicate the insurance commission type and level to apply to insurance benefits. The commission amounts shown are inclusive of GST. Note: From 1 July 2014, insurance commission will only be paid for Flexible Lifetime Super where insurance was in place prior to 1 July Cross one box only. Upfront Hybrid Level 112.8% Initial, 11% pa Ongoing commission 70% Initial, 16.5% pa Ongoing 22% Level 90.2% Initial, 11% pa Ongoing commission 56% Initial, 16.5% pa Ongoing 17.6% Level 67.7% Initial, 11% pa Ongoing commission 42% Initial, 16.5% pa Ongoing 13.2% Level 45.1% Initial, 11% pa Ongoing commission 28% Initial, 16.5% pa Ongoing 8.8% Level 22.6% Initial, 11% pa Ongoing commission 14% Initial, 16.5% pa Ongoing 4.4% Level 0% Initial, 11% pa Ongoing 0% Initial, 16.5% pa Ongoing 0% Initial, 0% pa Ongoing Commission details for AMP Flexible Super Super (Super Protection) Upfront Hybrid Level 120% Initial, 12.5% pa Ongoing commission 85% Initial, 22% pa Ongoing 24% Level 96% Initial, 12.5% pa Ongoing commission 68% Initial, 22% pa Ongoing 19.2% Level 72% Initial, 12.5% pa Ongoing commission 51% Initial, 22% pa Ongoing 14.4% Level 48% Initial, 12.5% pa Ongoing commission 34% Initial, 22% pa Ongoing 9.6% Level 24% Initial, 12.5% pa Ongoing commission 17% Initial, 22% pa Ongoing 4.8% Level 0% Initial, 12.5% pa Ongoing 0% Initial, 22% pa Ongoing 0% Initial, 0% pa Ongoing Note: AMP will arrange medicals on your behalf. If you prefer to arrange medicals yourself, please cross the box. Notes 5 of /14