1
NESS Super Pty Ltd ABN 28 003 156 812 AFSL 238945 RSE L0000161 MySuper Authorisation 72229227691044 as trustee of NESS Super ABN 72 229 227 691 RSE R1000115 ACTIVATE MY INSURANCE FORM This form is for new members who are under the age of 25 who wish to activate insurance. Please return this completed form to: Email: n[email protected] Post: NESS Super, Locked Bag 20, Parramatta NSW 2124 If you have any questions or require assistance with completing this form, please do not hesitate to contact us between 8.30am and 6.00pm (Sydney time) Monday to Friday on 1800 022 067. 1. Your Personal details (please complete in full) DOB Surname Address Suburb State Postcode Home phone Mobile Email 2. Activate My Insurance (PLEASE TICK THE BOX BELOW TO ACTIVATE YOUR INSURANCE) I WANT TO ACTIVATE MY INSURANCE AS A NEW MEMBER OF NESS SUPER. THIS WILL PROVIDE ME WITH TWO UNITS OF DEATH & TPD COVER AND PROVIDE DEFAULT INCOME PROTECTION FOR UP TO 75% OF MY INCOME PLUS UP TO 10% SUPER FOR 2 YEARS (104 WEEKS). I understand that by making this election I am making an election to opt-in for automatic insurance in accordance with 'Protecting your Super' and 'Putting Member's Interest First'. I understand that I may cancel this insurance at any time. 3. Declaration & Disclosure I declare and understand that: 1. All statements and declaration given by me in this application are true and correct. 2. I consent to NESS Super collecting and using my personal information to manage my superannuation and comply with relevant legislation. 3. I acknowledge that NESS Super may disclose my personal information to other parties including NESS Super’s Insurer, professional advisors, government bodies and my employers as outlined in NESS Super’s Privacy Policy. 4. I’ve had the opportunity to read and understand the insurance product and the 'NESS Super Employed Division Insurance Guide' as well as the NESS Super PDS. 5. I understand that any information provided by the Trustee of NESS Super is of a general or factual nature only and does not consider my personal investment objectives, financial situation or needs. 6. I am aware of NESS Super’s recommendation to obtain financial advice when investing in a financial product as NESS Super. Privacy Statement For further information on the collection, use and disclosure of your personal information, refer to our Privacy Policy at www.nesssuper.com.au or call us on 1800 022 067. Signature Date Given names
