FUNERAL iNsURANcE At MBF by cuiliqing


									FUNERAL iNsURANcE
Product Disclosure Statement
1 January 2011
                                                                    About this Product Disclosure Statement
                                                                    Summary of benefits                                     2
                                                                    What is Funeral Insurance at MBF?                       3
                                                                    About your premiums                                     7
                                                                    Easy steps to applying for Funeral Insurance at MBF     10
About this Product Disclosure Statement                             Additional Information about Funeral Insurance at MBF   11
This Product Disclosure Statement (PDS) has been
prepared to help you make an informed decision about                Privacy and your personal information                   17
Funeral Insurance at MBF. Any advice in this PDS is
general advice only and does not take into account your             Your duty of disclosure                                 20
individual financial situation, needs or objectives. You
should consider this PDS before making any decision                 Definitions                                             21
about whether to hold or acquire this product.
Your application for insurance is subject to acceptance by
ClearView Life Assurance Limited.
This PDS has been prepared with the most up-to-date
information available at the time of production.
In the event of an omission of information or if there is a
materially adverse change to the information, ClearView
Life Assurance Limited will issue a supplementary or
replacement PDS.
Information that is not materially adverse is subject to
change from time to time. More up-to-date information
may be available by visiting our website at
We will give you a paper copy of any updates (free of
charge) if you request them.
Many of the terms/words used in this document have
specific meanings. These words are italicised and their
meanings are explained in the Definitions section. You
should consult this section and understand the definitions
prior to making any decision in relation to this product.
In this PDS ‘you’ refers to the Policy Owner and/or the Life
Insured, as the context requires, and ‘we/us/our/insurer’
refers to ClearView Life Assurance Limited. ClearView Life
Assurance Limited is a company within ClearView.
Funeral Insurance at MBF is issued by ClearView Life
Assurance Limited. Bupa Australia Pty Limited and Bupa
Australia Health Pty Ltd do not underwrite or in any way
guarantee Funeral insurance at MBF or any financial
advice provided.

Funeral Insurance at MBF
Product Disclosure Statement 1 January 2011
This is an important document and should be kept in a safe place.
Issued by: ClearView Life Assurance Limited ABN 12 000 021 581
AFS Licence No. 227682

                 Benefits                                                               Funeral Insurance

    FUNERAL iNsURANcE                                       WHAt is FUNERAL
    At MBF                                                  iNsURANcE At MBF?
    Summary of Benefits                                     Funeral Insurance at MBF offers valuable life
                                                            insurance protection
          Death Benefit*
                                                            Funeral Insurance at MBF is designed to pay a
          Terminal Illness Benefit                          lump sum benefit in the event of your death or
                                                            being diagnosed with a Terminal Illness. This cover
          Choice of cover, ranging from $5,000 to $50,000   is world wide, 24 hours a day.
          Guaranteed acceptance, regardless of health
                                                            Why insure your life under Funeral Insurance
          24 hour worldwide protection                      at MBF?
          Cover automatically increases each year           The lump sum benefit payable under Funeral
          to keep pace with Inflation                       Insurance at MBF can be of enormous help to
                                                            your loved ones, ensuring they are not left with
          Death benefit is doubled if death is the          a financial burden in the event of your death or
          result of a Motor Vehicle Accident                Terminal Illness.
          Increased discounts the longer you hold           For example, you may want to provide money to
          your cover                                        settle some small debts or simply cover the cost
          Premiums waived from age 90                       of your funeral (which can be several thousand
                                                            dollars). Whatever the reason, you will find that
                                                            Funeral Insurance at MBF offers simple, affordable
                                                            life insurance.
    PLUs … Additional benefits for
    MBF Health insurance Members                            Who can apply for Funeral Insurance at MBF?
                                                            Provided you are a Permanent Australian Resident
          10% discount on premiums                          aged 18 – 75 (inclusive) at the time of applying for
                                                            Funeral Insurance at MBF, we guarantee to accept
          An extra 10% paid on all claims
                                                            your application for cover, no matter the state of
          Private health insurance premium waiver           your health.

          in the event of Terminal Illness                  There are no complicated forms or health
                                                            questions to answer, enabling people with existing
    * Limited to Accidental Death in first 2 years.         health issues to obtain valuable cover.

2                                                                                                                  3
    What are the benefits and when are                     Cover Indexation Benefit
    they payable?
                                                           Each year upon the Policy Anniversary, we will
    When you apply for cover, you select the Sum           automatically increase your cover to keep your
    Insured. The amount selected must be in multiples      insurance in line with Inflation. This benefit
    of $5,000 and is subject to the minimum and            can help your level of cover to keep pace with
    maximum guidelines in the table below.                 inflationary increases for the costs you are trying
                                                           to cover, such as the cost of a funeral.
      Age at Application     Minimum         Maximum
                                                           The amount of the increase will be the greater
           18 - 54           $10,000          $50,000      of the Consumer Price Index (CPI) and 5%, and
                                                           premiums will be adjusted accordingly for this
           55 - 75            $ 5,000         $50,000      valuable increase in cover.

    During the first 24 months of the Policy, the Sum      The Cover Indexation Benefit will cease to be
    Insured will only be paid if you die as a result of    offered from the Policy Anniversary after the Life
    an Accident. This is referred to as the Accidental     Insured turns age 90. Up until this time, you may
    Death Only Period. After that period, the Sum          opt in or out of the Cover Indexation Benefit by
    Insured will be paid if you die from any cause or      notifying us in writing at least 30 days before your
    become Terminally Ill.                                 next Policy Anniversary.

    If you increase the Sum Insured, the Accidental        Motor Vehicle Accident Double Benefit
    Death Only Period will apply to the amount of the      If the Life Insured dies as a result of a Motor
    increase.                                              Vehicle Accident, we will double the Sum Insured
    If your Policy is reinstated, the Accidental           paid.
    Death Only Period will restart from the date of        This benefit will only be paid if:
                                                           •   the Life Insured dies as a result of an Accident
    If you die from any cause other than an Accident           in which the Life Insured was a passenger or
    during the first 24 months and no claim is paid,           the driver of a Motor Vehicle;
    we will refund the premiums you have paid on the
    Policy. This feature of the Policy is referred to as   •   the Accident occurs while the Policy is in force;
    the Premium Refund Benefit.                                and

    Who is the benefit paid to?                            •   death occurred immediately or within 90 days
                                                               after the Accident.
    You can tell us who you want the death benefit
    paid to by nominating them as your beneficiary. You
    can nominate up to two beneficiaries by completing
    the “Nomination of Beneficiary” section at the
    time of application. You may change a Nominated
    Beneficiary or revoke a previous nomination at any
    time prior to a claim event occurring.

4                                                                                                                  5

    Loyalty Discount Benefit
                                                          ABOUt YOUR PREMiUMs
    To reward you for your loyalty, we will give you
    a discount on your Funeral Insurance at MBF           The cost of cover depends on your age and your
    premium, once you have held your Policy for three     chosen level of Sum Insured, which must be in
    years or more. The discount applies for the life of   multiples of $5,000.
    the Policy, increasing each year up to a maximum
    of 10% after 10 years.                                Enjoy a level premium rate for the first 3 years
                                                          Usually the cost of your cover increases each
     Policy Held For            Discount Applied
                                                          year as you get older. However, to help you
                                                          manage costs, your premium rate is fixed for
       3 years                        3%
                                                          the first 3 years from the Policy Start Date.
       5 years                        5%
                                                          Your premium rate will then increase on the
       10 years                       10%                 3rd Policy Anniversary and will increase each
                                                          year in line with your age.

                                                          The following table shows the monthly premium for
    Private Health Insurance Premium Waiver
                                                          various Sums Insured.
    If the Life Insured is diagnosed as Terminally Ill
    and is a current MBF Health Insurance Member, we      All existing MBF Health Insurance Members
    will reimburse up to 6 months of your MBF health      receive a 10% discount on Funeral Insurance
    insurance premiums, subject to a maximum of           at MBF premiums.
    $2,000 in total.
                                                          Monthly Premiums for MBF Health Insurance Members
    Reward Cover Benefit
                                                                                       Sum Insured
    In the event of death or Terminal Illness, the Sum
    Insured paid will be increased by 10% if the Life      Age at   $5,000   $10,000    $15,000      $30,000   $50,000
    Insured is a current MBF Health Insurance Member
                                                           18-39     N/A      $13.84     $20.77       $41.53   $69.22
    at the time of claim.                                   40       N/A      $13.95     $20.93       $41.86   $69.77
                                                            41       N/A      $14.18     $21.27       $42.54   $70.90
                                                            42       N/A      $14.53     $21.79       $43.58   $72.63
                                                            43       N/A      $15.00     $22.50       $45.00   $75.00
                                                            44       N/A      $15.53     $23.30       $46.60   $77.67
                                                            45       N/A      $16.13     $24.20       $48.40   $80.67
                                                            46       N/A      $16.80     $25.21       $50.41   $84.02
                                                            47       N/A      $17.46     $26.19       $52.38   $87.30
                                                            48       N/A      $18.10     $27.15       $54.29   $90.49
                                                            49       N/A      $18.77     $28.15       $56.30   $93.84
                                                            50       N/A      $19.58     $29.37       $58.73   $97.89
                                                            51       N/A      $20.59     $30.89       $61.78   $102.97
                                                            52       N/A      $21.78     $32.67       $65.35   $108.91
                                                            53       N/A      $23.11     $34.66       $69.32   $115.54
                                                            54       N/A      $24.52     $36.79       $73.57   $122.62
                                                            55      $13.02    $26.04     $39.06       $78.12   $130.20
                                                            56      $13.83    $27.66     $41.49       $82.99   $138.31

6                                                                                                                        7
                                 Sum Insured                       Convenient payment options

     Age at   $5,000   $10,000    $15,000      $30,000   $50,000   Premiums are payable in advance, either monthly
     Entry                                                         or annually. If you pay annually, you pay 12 times
      57      $14.70    $29.40     $44.10      $88.19    $146.99
      58      $15.63    $31.25     $46.88      $93.76    $156.27
                                                                   the monthly premium.
      59      $16.62    $33.24     $49.86      $99.72    $166.20
      60      $17.68    $35.36     $53.05      $106.09   $176.82   For your convenience we have a number of easy
      61      $18.82    $37.65     $56.47      $112.94   $188.23   payment options for you to choose from, which
      62      $20.05    $40.10     $60.14      $120.29   $200.48   helps take the worry out of remembering to pay
      63      $21.36    $42.73     $64.09      $128.18   $213.64
                                                                   your premiums on time.
      64      $22.77    $45.55     $68.32      $136.64   $227.73
      65      $24.28    $48.56     $72.84      $145.69   $242.81
      66      $25.90    $51.79     $77.69      $155.37   $258.95                              Monthly        Yearly
      67      $27.62    $55.25     $82.87      $165.74   $276.24
      68      $29.47    $58.95     $88.42      $176.85   $294.74    Direct Debit from your
      69      $31.46    $62.91     $94.37      $188.73   $314.56
                                                                    nominated bank account
      70      $33.58    $67.15     $100.73     $201.46   $335.76    Credit Card
      71      $35.92    $71.83     $107.75     $215.49   $359.15    (Visa and Mastercard)
      72      $38.49    $76.99     $115.48     $230.96   $384.93
      73      $41.33    $82.66     $124.00     $247.99   $413.32    Cheque
      74      $44.39    $88.78     $133.17     $266.33   $443.89
      75      $47.68    $95.36     $143.04     $286.08   $476.79

    Aged 90 premium waiver
    Commencing from the Policy Anniversary after
    the Life Insured turns age 90, premiums for your
    Funeral Insurance at MBF Policy will be waived.

    Changing your cover
    Should your needs change, you can select another
    Sum Insured amount from those available and we
    will adjust your premium accordingly. Sum Insured
    amounts can be increased or decreased only in
    multiples of $5,000.

       Need help?
       If you would like a quote for a Sum Insured

                                                                                      10% discOUNt
       not shown above, please call us on 132 623.

                                                                                      FOR MBF HEALtH iNsURANcE MEMBERs
         Easy Steps                                                                 Additional Information

EAsY stEPs tO                                          AdditiONAL iNFORMAtiON
APPLYiNg FOR FUNERAL                                   ABOUt FUNERAL
iNsURANcE At MBF                                       iNsURANcE At MBF
If you are a Permanent Australian Resident aged        When does cover start?
18 – 75 (inclusive) just follow these easy steps to    Once your application has been approved, we will
apply for Funeral Insurance at MBF.                    confirm for you in writing. We will also issue you
                                                       with a Policy Document and Policy Certificate.
1. Read this PDS carefully – it contains important
   information about the product, including details    The Policy Certificate sets out the details of your
   of benefits, costs and exclusions that may apply.   cover, including the Life Insured, the Sum Insured
                                                       and the Policy Start Date.
2. Choose the amount of cover you want. Cover is
   available from $5,000 to $50,000, in multiples of   This is an important document and should be kept
   $5,000.                                             in a safe place.
3. Decide how you want to pay for your cover.
                                                       When does the cover cease?
   For your convenience, your monthly or annual
   premiums can be automatically deducted from         Funeral Insurance at MBF is a guaranteed
   your bank account or credit card. If you prefer,    renewable Policy, which means that provided you
   you can also pay annually by cheque.                continue to pay your premiums when due, we
                                                       guarantee to continue to provide cover for the Life
4. Complete the application form attached.             Insured until the first of the following occurs:
   For more information call 132 623, visit or pop by your MBF centre.           •   the Life Insured dies;

                                                       •   the Life Insured becomes Terminally Ill;

                                                       •   we cancel your Policy following your written

                                                       •   we cancel your Policy because premiums are
                                                           unpaid, as and when due; or

                                                       •   we cancel your Policy in accordance with our
                                                           rights in relation to your duty of disclosure.

     When all cover ceases, the Policy ceases. The           •   being driven by a person who was under
     premiums you pay provide for the cost of your               the influence of a drug (other than a drug
     cover. The Policy does not provide for a residual           prescribed by a Doctor and taken as directed);
     cash or surrender value. This means that if you             or
     cancel your Policy after the cooling off period
     or if we cancel your Policy in accordance with          •   being driven by a person who was under the
     our rights, you will not receive a residual cash            influence of alcohol in excess of the legal blood
     or surrender value. If however you have paid an             alcohol limit.
     annual premium, we will pay a pro-rata premium
     refund of any unused premium on your Policy.            Can premium rates change?
                                                             Premium rates are not guaranteed and we reserve
     When benefits will not be paid                          the right to review our rates at any time. Any
     No benefit will be paid within 24 months of the         changes to our standard rates will apply to all
     Policy Start Date or the date of reinstatement of the   Funeral Insurance at MBF policies in a defined
     Policy, whichever is the later, if the cause of death   group, we will not single you out for a premium
     was not an Accident.                                    increase. If we need to change our rates, you will
                                                             be given 30 days notice in writing.
     If the Sum Insured has been increased, the amount
     of the increase will not be paid if within 24 months
     after the date of the increase the Life Insured dies
     and the cause of death was not an Accident.

     No Terminal Illness benefit will be paid if the Life
     Insured is diagnosed as Terminally Ill within 24
     months of the Policy Start Date or reinstatement of
     the Policy, whichever is the later.

     The additional Motor Vehicle Accident benefit will
     not be paid if the Motor Vehicle in which the Life
     Insured was travelling was:

     •   in an unsafe condition, as determined by our

     •   being used in a race, trial, contest or for
         unlawful purposes;

     •   being driven unlawfully;

12                                                                                                                   13
          Insurance Policies

     ABOUt iNsURANcE                                           What is the cooling off period?

     POLiciEs issUEd BY
                                                               If for any reason you decide that your Policy
                                                               does not meet your needs, you can cancel it by
     cLEARViEW LiFE                                            notifying us in writing within 14 days, starting on
                                                               the earlier of:
     AssURANcE LiMitEd                                         •   the date you receive your Policy; or

     How do I make a claim?                                    •   5 business days after your Policy Start Date.
     The procedure for making a claim is outlined in           This is known as the cooling off period. Provided
     the Policy Document. In particular, we need to be         you cancel your Policy within the cooling off period,
     notified of a claim as soon as possible. We will          we will refund any premiums you have paid.
     need all the evidence we reasonably regard as
     necessary to establish entitlement to a benefit.          You will not be able to cancel your Policy under the
                                                               cooling off period provision if you have exercised
     We are committed to paying claims as quickly as           any rights under it, for example, if you have made
     possible, and have a service standard of 48 hours,        a claim under your Policy.
     once all claims requirements have been received in
     our office.                                               What are the tax implications?

     What will happen if I stop paying my premiums?            Generally premiums are not tax deductible and
                                                               benefits are free of personal tax. This is a general
     To ensure your Policy remains in force you must           statement based on the continuance of taxation
     pay your premium, as and when due. If you don’t           laws and their interpretation that were current
     pay your premium within 30 days of the due date,          at the date this document was prepared. You
     we will write to you explaining how we can cancel         should seek advice from a suitably qualified
     your Policy. If we cancel your Policy all cover will      taxation professional, in relation to your particular
     cease and you will not be able to make a claim for        circumstances.
     an event which occurs after the date cover ceases.
                                                               Is my cover guaranteed renewable?
     You may apply to ClearView Life Assurance Limited
     to reinstate your Policy after it is cancelled, subject   If you pay your premiums and comply with Policy
     to our approval and payment of outstanding                conditions, your cover is guaranteed renewable
     premiums.                                                 up until the Policy Expiry. This means that we
                                                               cannot cancel your cover or increase the premium
     Are there any other charges?                              because of any change to your state of health,
                                                               occupation or pastimes.
     The insurance premium is the only amount payable.
     There are no additional charges. The premium
     includes allowances for current government
     charges and taxes.

     We may pass on to you any applicable new or
     increased government taxes or charges.

14                                                                                                                     15

     What are the complaint handling procedures for
     ClearView Life Assurance Limited?                      PRiVAcY ANd YOUR
     At ClearView Life Assurance Limited, customer          PERsONAL iNFORMAtiON
     satisfaction is very important to us. Should you be
     dissatisfied with your Funeral Insurance at MBF or     We are committed to ensuring the confidentiality
     with ClearView Life Assurance Limited, please let us   and security of your personal information including
     know by telephoning 132 623.                           sensitive information. All personal information will
                                                            be handled in accordance with the Privacy Act.
     We do our best to resolve all complaints within
     7 days of notification. If your complaint is not       Collection, Use and Disclosure of your
     resolved to your satisfaction, or you are not          Personal Information
     satisfied with the progress after 7 days, please
     contact:                                               We need to collect, use and disclose your personal
                                                            information including sensitive information or that
     Complaints Manager                                     of the Life Insured (if not you) in order to consider
     ClearView Life Assurance Limited                       your application and to provide the cover you have
     Reply Paid 4232                                        chosen, administer the Policy and assess any claim.
     Sydney NSW 2001                                        You or the Life Insured can choose not to provide
                                                            us with some or all of your personal information
     If you are not satisfied with how we respond to        including sensitive information, but this may affect
     your enquiry or complaint or we have not dealt         our ability to provide the cover.
     with your complaint within 45 days (or within any
     extended period you approve), you may contact the      By providing your personal information including
     Financial Ombudsman Service on 1300 780 808,           sensitive information or that of the Life Insured you
     or by writing to the address below. This service is    and the Life Insured acknowledge and declare that,
     provided to you free of charge.                        and consent to the following:

     The Manager                                            •   we can collect and use your personal
     Financial Ombudsman Service                                information including sensitive information
     GPO Box 3                                                  for the following purposes: to assess any
     Melbourne VIC 3001                                         application; underwrite; price and issue any
                                                                Policy; calculate or offer benefits and discounts;
                                                                administer the Policy; to investigate, assess and
                                                                pay any claim;

                                                            •   for these purposes we can collect your personal
                                                                information including sensitive information from,
                                                                and disclose it on a confidential basis to: our
                                                                related entities; outsource providers; government
                                                                departments and agencies; investigators;
                                                                lawyers; advisers; medical and health service
                                                                providers; reinsurers; other insurers; anyone
                                                                acting on our behalf; and the agent of any of

16                                                                                                                   17
     •   where you provide personal information               Our Information Handling Policy
         including sensitive information to us about
                                                              Further information on how we handle your
         another person, you are authorised to provide
                                                              personal information is explained in our Information
         their information to us, and that you will inform
                                                              Handling Policy including:
         that person who we are, how we use and
         disclose their information, and that they can        •   how to contact us regarding Privacy;
         gain access to that information (unless doing so
         would pose a serious threat to the life or health    •   how to inform us to change your marketing
         of any individual).                                      consent; and

     Marketing                                                •   how to access your personal information.

     We are committed to providing you with access to a       If you have any questions, comments or concerns
     range of leading products and services.                  regarding privacy matters or any other matter, or if
                                                              you would like a copy of our Information Handling
     In order to do this we will use your personal            Policy, please call us on 1800 213 839.
     information to offer you other products and
     services. We may disclose your personal information
     on a confidential basis to our related entities within
     ClearView so that they can also offer you products
     and services.

     By providing your personal information to us you
     acknowledge that, and consent to:

     •   us collecting and using your personal
         information to contact you for market research
         and to provide you information and offers
         about products and services offered by us,
         our related entities, within ClearView and other
         organisations whose products and services we

     •   us disclosing your personal information on a
         confidential basis for these marketing purposes
         to our related entities and to any agent of them;

     •   you will inform us if you do not want your
         personal information to be used, or disclosed
         for these marketing purposes, by telephoning
         1800 213 839.

18                                                                                                                   19
              Disclosure                                                                        Definitions

     YOUR dUtY OF                                             dEFiNitiONs
     discLOsURE                                               ‘Accident/Accidental’ means an unintended and
                                                              unexpected event, which occurs while this Policy is
     Under the Insurance Contracts Act 1984, the person       in force and where the Life Insured suffers physical
     who is the Life Insured, has a duty, before the          injuries caused solely and directly by visible, violent
     contract of life insurance is entered into with us, to   and external means and where the injury is not
     disclose every matter that the Life Insured knows,       self inflicted.
     or could reasonably be expected to know, that is
     relevant to our decision whether to accept the risk      For the avoidance of doubt, Accident excludes:
     of the insurance and, if so, on what terms.
                                                              •   suicide and/or events where the injury and/or
     The Life Insured has the same duty to disclose               death was unintended and unexpected but was
     those matters to us before the insurance is                  the result of an intentional act;
     extended, varied or reinstated. This duty, however,
     does not require disclosure of a matter:                 •   death or injury due to natural causes;

     •   that diminishes the risk to be undertaken by us;     •   vascular Accidents;

     •   that is of common knowledge;                         •   allergic reactions; or

     •   that we know or, in the ordinary course of our       •   any event relating directly or indirectly to any
         business, ought to know; or                              surgical procedure.

     •   if we have waived in writing our requirement to      ‘Accidental Death’ means death resulting from an
         comply with this duty.                               Accident either immediately or within 90 days after
                                                              the Accident.
                                                              ‘Accidental Death Only Period’ means the period
     If the Life Insured fails to comply with their duty      where the Sum Insured will only be paid if the
     of disclosure and we would not have entered              Life Insured dies as a result of an Accident. This
     into the contract on any terms if the failure had        period is 24 months commencing on the Policy
     not occurred, we may void the contract within 3          Start Date, date of reinstatement or the date of a
     years of entering into it. If your non-disclosure is     Sum Insured increase (but only in respect of the
     fraudulent, we may void the contract at any time.        increase amount). No Terminal Illness benefit will be
     If we are entitled to void a contract of insurance       paid if the Life Insured is diagnosed as Terminally
     we may, within 3 years of entering into it, elect not    Ill during the Accidental Death Only Period.
     to void it but reduce the amount of the insured
     benefit in accordance with a formula that takes          ‘Inflation’ means the last weighted average of
     into account the premium that would have been            8 capital cities combined Consumer Price Index
     payable if all relevant matters had been disclosed       published by the Australian Bureau of Statistics as
     to us.                                                   at the time indexation is being calculated. If this
                                                              index is no longer being published, we will use
                                                              another index which we consider is similar to it.

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     ‘Life Insured’ means the Life Insured stated in the      ‘Permanent Australian Resident’, means the holder
     Policy Certificate.                                      of a current valid Australian passport or a person
                                                              who has been granted a permanent resident visa.
     ‘MBF Health Insurance Member’ means a customer
     who holds current private health insurance cover         ‘Policy’ means the Funeral Insurance at MBF Policy,
     issued by a Bupa Australia company.                      which is a contract of insurance between you
                                                              and ClearView Life Assurance Limited, and which
     ‘Medical Practitioner’ means a person acceptable         comprises the Funeral Insurance at MBF Policy
     to us who is qualified, registered and practising in     Document, the Policy Certificate (as applies from
     Australia as a Medical Practitioner, other than:         time to time) and any other documents we issue to
                                                              you at time of acceptance of cover.
     -   you;
                                                              ‘Policy Anniversary’ means an anniversary of the
     -   the Life Insured;
                                                              Policy Start Date.
     -   a member of the Life Insured’s or your
                                                              ‘Policy Certificate’ is the Policy Certificate issued
         immediate family;
                                                              upon confirmation of issue of cover or any
     -   your business associate; or                          replacement Policy Certificate we issue.

     -   the Life Insured’s business associate.               ‘Policy Owner’ means the Policy Owner stated in
                                                              the Policy Certificate.
     We may also accept a person with similar
     qualifications who is registered and practising          ‘Policy Start Date’ means the date the Policy starts,
     as a Medical Practitioner in another country.            as stated in the Policy Certificate.

     ‘Motor Vehicle’ means a registered vehicle               ‘Premium Refund Benefit’ means we will refund all
     (including a motor bike), which is:                      premiums paid on the Policy if the Life Insured dies
                                                              from any cause other than an Accident during the
     •   able to be driven on public roads and                Accidental Death Only Period and no other claim is
         motorways;                                           paid.

     •   used purely for business and/or personal use;        ‘Sum Insured’ means the insured amount stated in
         and                                                  the Policy Certificate.

     •   in use for the purpose for which it is registered.   ‘Terminally Ill/Terminal Illness’ means an illness
                                                              that, in the opinion of an appropriate specialist
     ‘Motor Vehicle Accident’ means an Accident               Medical Practitioner, will lead to the death of the
     involving a Motor Vehicle that occurs while the          Life Insured within 12 months.
     Policy is in force, where the Life Insured was the
     driver or passenger of the Motor Vehicle.

     ‘Nominated Beneficiary’ means a Nominated
     Beneficiary selected by you whilst the Policy is in
     force and prior to any claim and confirmed by us
     in writing.

22                                                                                                                    23
CALL     132 623


POP BY   your MBF centre

                   ClearView Life Assurance Limited
                            Level 4, 50 Bridge Street
                                   Sydney NSW 2000
          Issued by: ClearView Life Assurance Limited
                                  ABN 12 000 021 581
                              AFS License No. 227682
                                          CVWMBFL 0036
                                                                                                                                   10% PREMIUM DISCOUNT FOR
                                                                                                                              MBF HEALTH INSURANCE MEMBERS
This application relates to Funeral Insurance at MBF, Product Disclosure Statement (PDS) dated 1 January 2011.
Please do not complete this application if you have not read the PDS.

Application form – Funeral Insurance at MBF
To be eligible to apply, you must be a Permanent Australian Resident aged between 18 and 75 (inclusive).
If you wish to apply for cover for a second person, you will need a separate application form.
Send your completed application form (no stamp required) to: Clearview Life Assurance Limited. Reply Paid 4232, Sydney NSW 2001.

Select amount of cover (tick one box only, or specify amount)

        $5,000                             $10,000                              $15,000                     $20,000                     $50,000                            Other Amount
          (min*)                                                                                                                         (max.)                    (must be a multiple of $5,000)


Note: $10,000 is the minimum amount of Funeral Insurance at MBF cover for an applicant up to and including age 54.

Life Insured details (please print)

Title   Given name(s)                                                                     Initial           Mobile phone number                    Date of birth                                 Sex (M/F)

Surname                                                                                                     Email address


                                                                                                            1. Are you a permanent resident of Australia?

                                              State                           Postcode                          Yes                No

Home phone number                                                                                           2. Are you an MBF Health Insurance Member?

                                                                                                                Yes                No

Nomination of beneficiaries

  Full name of Beneficiary                                                                            Address                                     Date of birth         Relationship   Portion of total
                                                                                                                                                                         to the Life     benefit %*

                                                                                                    State                   Postcode

                                                                                                    State                   Postcode

*Each portion must be a whole percentage and the total must add up to 100%.

My decision to apply for this insurance is based on the material received and my understanding of the information, including the PDS.
I have read and understand the ‘Your Duty of Disclosure’ and ‘Non-Disclosure’ statements in the PDS and confirm that I am a permanent Australian resident aged
between 18 and 75 (inclusive).
I have read and consent to the collection, use and disclosure of my personal information including sensitive information, as set out in the ‘Privacy and Your Personal
Information’ section of the PDS, including the Marketing Purposes section.
I understand that the insurance applied for does not begin until Clearview Life Assurance Limited accepts my application.

    Applicant’s signature

Payment Authority
This authority must be completed if you wish to pay by automatic deductions from either a credit card or a bank account.

Select preferred payment method (tick one box only)

I wish to pay my premiums:

        Monthly (by automatic deductions from my bank account or credit card) – please complete payment authority

        Annually (by automatic deductions from my bank account or credit card) – please complete payment authority

        Annually (by manual payments) – please make your cheque for 12 times the monthly premium, payable to Clearview Life Assurance Limited

Option A – Credit card                                                                             Cardholder’s name (as shown on card)                           Expiry date

I authorise Clearview Life Assurance Limited to deduct payments from my:
                                                                                                     Cardholder’s signature
        MasterCard              Visa
                                                                                                     Cardholder’s signature
Credit card number

Option B – Bank account

I authorise the payment of premiums for the Policy by automatic debit from my account in accordance with the Direct Debit Request below:

Request and authority to debit

ClearView Life User ID 022829 may debit and/or charge any amount through the Bulk Electronic Clearing System, from the account nominated
on this form. Each debit or charge must be effected according to the Service Agreement.

Direct Debit request – authority to debit account:

Title    Given name(s)                                                                             Name of account holder

Surname                                                                                            BSB number                        Account number



                                                                                                   Before signing this section, please read the Direct Debit Service Agreement in
                                              State              Postcode
                                                                                                   the PDS. If your Authorisation is accepted, the full Service Agreement will be
                                                                                                   sent to you with your Policy Document. Your signature on this form confirms
Details of financial institution                                                                   you have authorised ClearView Life Assurance Limited to deduct premiums from
                                                                                                   your account according to the Service Agreement and that you have checked
Name of financial institution
                                                                                                   the account details and confirm they are correct. If a joint account, please have
                                                                                                   all account holders sign. If you are signing for and on behalf of another person,
                                                                                                   please state the capacity in which you sign, in the signature box below.

Address of financial institution
                                                                                                     Cardholder/s signature

                                              State              Postcode

Thank you for your application
                                                                                                   Send your completed application form (no stamp required) to:
 Consultant Name
                                                                                                   Clearview Life Assurance Limited
                                                                                                   Reply Paid 4232
                                                                                                   Sydney NSW 2001
 Consultant ID (BOSS)                  Retail Centre Name
                                                                                                   Issuer: Clearview Life Assurance Limited
                                                                                                   ABN 12 000 021 581
                                                                                                   AFS Licence No. 227682
                                                                                                                                                                        CVWMBFL 0036

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