TOC - INDUSTRY DIVISION INSURANCE BOOKLET · for definitions not in this booklet. The information in this Insurance Booklet forms part of the Product Disclosure Statements (PDS) for

Insurance BookletPERSONAL DIVISION

Issued 1 October 2019

Insurance cover is issued by OnePath Life Limited ABN 33 009657 176 AFSL 238 341 (“the Insurer”) and subject to theterms and conditions of the Insurance Policies issued to ClubPlus Superannuation Pty Ltd (“Trustee”) by OnePath LifeLimited (Insurance Policies). This Insurance Booklet providesa summary of the key terms and conditions of the InsurancePolicies. Where information is summarised in a brochure,information guide, or document other than the InsurancePolicies themselves, it does not represent a completedescription of the terms on which the insurance cover isprovided.

The Insurance Policies represent the concluded agreementsbetween the Trustee and the Insurer and, in the event of aninconsistency with this booklet the terms of the InsurancePolicies will prevail. You can contact Club Plus Super on 1800680 627 if you would like a copy of the Insurance Policies.

Some words or terms in this Insurance Booklet have a specialmeaning. These words have been capitalised and are explainedin the definitions. You should refer to the Insurance Policiesfor definitions not in this booklet.

The information in this Insurance Booklet forms part of theProduct Disclosure Statements (PDS) for the Personal Divisiondated 1 October 2019.

This Insurance Booklet for Personal division is issued by ClubPlus Superannuation Pty Ltd ABN 26 003 217 990 AustralianFinancial Services Licence No. 245362, as Trustee for theClub Plus Superannuation Scheme ABN 95 275 115 088.

Club Plus Superannuation Pty Ltd holds RegisterableSuperannuation Entity Licence No.L0000529 and Club PlusSuperannuation holds Fund Registration No. R1000757.

CONTENTS

41 Death and Total and Permanent Disablement (TPD) cover

182 Income protection cover

293 Other insurance information

Cover when you join Club Plus SuperWhat type of cover can I apply for without havingto provide health information?

When you first join the Personal Division of Club PlusSuper, you may be eligible to apply for one unit ofDeath and TPD insurance cover, without having to bemedically assessed by the Insurer (“automaticcover”).

This new member offer will be made within yourWelcome Letter, when Club Plus Super advises youof your membership number. To apply for this newmember offer you must be an Eligible Person asdescribed in the section 'Eligibility' and meet thepolicy requirements under 'Eligibility for automaticcover'. You must return the Personal member specialoffer form to us within 60 days of the date of theWelcome Letter. If we receive the Personal memberspecial offer form after the 60 days, you will not beeligible for the new member offer and you will needto apply for insurance cover by completing thePersonal Statement at the end of this booklet. Youcan only take up this offer once when you join ClubPlus Super.

What is the cost of automatic cover?

Death andTPD

($per unit perweek1)

TPD

($per unitper week1)

Death


Age Band

(age nextbirthday)

$1.19$0.23$0.9616 - 20

$1.20$0.30$0.9021 - 30

$2.76$0.81$1.9531 - 45

$2.42$1.25$1.1746 - 55

$1.50$0.68$0.8256 and over2

1 The cost of each unit of cover includes an amount retained inthe Fund to cover the costs of administering insurance. The costis 7 cents for Death units and TPD units, and 14 cents for Deathand TPD units.

2 Death cover ceases when you turn 70. TPD cover ceases whenyou turn 60.

How much cover can I apply for without havingto provide health information?

The following table shows the level of Death and TPDcover provided for 1 unit based on your age. Theamount of cover provided by a unit generally changesas you age, but the number of units you hold remainsconsistent, unless you apply to change your number

of units. This is different to fixed cover, which meansthe amount of cover provided stays the same, but thepremiums will change as you age (see "Fixed CoverPremium Scale").

You can vary the amount of your automaticcover subject to insurer's acceptance, by submittingan appropriate form to fix your level of cover (fixedcover), remove cover for TPD by electing Death Onlycover, increasing the number of units you hold orincreasing your fixed cover.

Any insurance cover you hold on the date you departAustralia will continue 24 hours a day, seven days aweek, anywhere in the world provided your insurancecover does not otherwise end under the policy. Forexample, your cover will end on the date Australiaceases to be your Permanent Place of Residence. Ifyou become terminally ill in accordance with policyterms and conditions, you will receive an advancepayment of your Death benefit.

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1 Death and Total and PermanentDisablement (TPD) cover

Insured Amount of 1 Unit of CoverAge next birthday

TPD coverDeath cover

$50,000$50,00016 - 21

$50,000$51,00022

$50,000$52,00023

$50,000$53,00024

$50,000$55,00025

$50,000$60,00026

$50,000$65,00027

$50,000$75,00028

$50,000$88,00029

$50,000$100,00030

$50,000$110,00031

$50,000$118,00032

$50,000$125,00033

$50,000$130,00034

$50,000$131,50035 - 40

$49,000$131,50041

$47,000$131,50042

$45,000$131,50043

$41,000$120,00044

$36,000$110,00045

$30,000$90,00046

$24,000$60,00047

$21,000$40,90048

$19,000$35,10049

$17,000$29,20050

$15,000$26,30051

$13,000$23,40052

$12,000$20,50053

$11,000$17,50054

$10,000$14,00055

$9,000$10,00056

$8,000$10,00057

$7,000$10,00058

$6,000$10,00059

$5,000$10,00060

N/A$7,50061 - 70

EligibilityYou must be an Eligible Person to obtain any type ofinsurance cover in Club Plus Super.

An Eligible Person is someone who:

is a member of Club Plus Super;is either an Australian Resident residing in oroutside Australia, or a holder of a Visa residingin Australia; andis at least 15 years old and not older than theMaximum Benefit Entry Age which is currently59 years for Personal Division members

on the date cover is due to commence orrecommence.

If you are applying for cover or additional cover viathe Personal Statement form, you must be workingin an occupation for which cover is available underthe Policy.

Eligibility for automatic cover

To be eligible for automatic cover when you join ClubPlus Super, you must;

return the Personal member special offer form tous within 60 days of the date of your WelcomeLetter;be a member of the Personal Division;not have previously been provided with automaticcover in the Personal Division in this account orany previous account with us; andnot be a Claiming Member at the time covercommences.

If you are a Claiming Member and meet all othereligibility requirements, automatic cover is providedas death only cover.

When automatic cover is subject to limitations

Health evidence is not required for automaticcover, however any automatic cover provided issubject to exclusions including a 3-year Pre-ExistingCondition exclusion. Please refer to “When will myclaim not be paid?” for details about the exclusionsthat apply to automatic cover. Your cover will continueto be subject to the exclusions until you apply to havethe exclusions removed and the insurer approves yourapplication. You can make such an application bycompleting the Personal Statement form at the endof this booklet and being underwritten by the Insurer.

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Changing your coverCan I reduce or cancel my cover?

You can reduce or cancel your cover at any time bycompleting an Insurance Variation, Cancellation orReduction form (“Insurance Variation” form) availableat the back of the booklet. Alternatively, you cancancel or opt out of your insurance cover over thephone by giving us a call on 1800 680 627. You alsohave the option to just opt-out of TPD cover by electingto have Death Only cover.

If you choose not to apply for automatic cover whenjoining, or aren’t eligible to apply, and apply for coverat a later date, you’ll need to complete the PersonalStatement form. After you submit your application,you will go through a process called “underwriting”which is the term used to describe the process theInsurer undertakes to assess your application forcover.

The Insurer may obtain and consider informationrelating to your health, medical, employment orfinancial situation and anything else that is relevantto your application for cover. The Insurer may acceptor decline your application, or offer cover based onnon-standard terms.

How can I increase my level of cover, or obtainnew cover after I join?

Additional or new cover can be applied for at any time,but you will need to complete the Personal Statementform (available at the back of this booklet) and beunderwritten by the Insurer. Insurance cover will besubject to acceptance by the Insurer.

You can apply for up to a maximum of $5,000,000of Death cover and $3,000,000 of TPD cover. Youcan apply for a higher amount of Death cover thanTPD cover by obtaining additional Death only cover,but you cannot hold a higher amount of TPD coverthan Death cover.

Read on about Life Events Cover and cover transfersections below, to find out how you might be able toincrease your cover.

What is Life Events Cover?

You can apply for extra Death, or Death and TPD cover(as applicable) without having to provide evidence ofhealth for the following significant life events, providedyour application form is accepted by the insurer:

milestone birthdays of 30, 40 and 50;marriage;

birth or adoption of a child;taking out a mortgage to buy a primary residenceor increasing an existing mortgage on a primaryresidence by at least $100,000;divorce;dependent child first starting primary orsecondary school;completion of an apprenticeship;death of spouse; andcompletion of a university undergraduate degree.

The amount of additional cover provided under thisoption depends on whether you hold units of coveror fixed cover:

For unitised cover, the additional amount is oneunit;For fixed cover, the additional amount is thelesser of 25% of your existing fixed amount ofcover and $250,000.

You can exercise this option once in any 12 monthperiod with a maximum of three increases during yourmembership in Club Plus Super. You must alreadyhold insurance cover when the significant life eventoccurs.

We must receive your application within 60 days ofthe life event or within 60 days of the date of the ClubPlus Super annual member statement you receiveimmediately after the life event (provided the life eventoccurred within 12 months of the date of the memberstatement), whichever is the later.

If you are not in Active Employment on the date youapply for Life Events Cover, the additional cover willbe Limited Cover. Limited Cover will be replaced withStandard Cover on the date immediately after youhave been in Active Employment for two consecutivemonths from the day increased cover starts. Pleaserefer to the Insurance Glossary for the definitions ofActive Employment and Limited Cover.

To apply, you will need to complete a Life EventsApplication form. If you have previously had anapplication for voluntary cover declined by the Insureryou will not be eligible for Life Events Cover. At thetime of applying, you must not be eligible to be paida benefit nor have made or be entitled to make aclaim because you have suffered an event for whichyou are insured for under any life insurance policywhether it is issued by OnePath Life or any otherinsurer.

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Can I transfer cover from another fund to ClubPlus Super?

If you have Death only or Death and TPD insuranceunder a group insurance policy through anothersuperannuation fund (other than a self- managedsuper fund) you may be able to transfer that cover("Previous Cover") to Club Plus Super by completingthe Insurance Transfer Form and satisfying theeligibility requirements.

You can apply to transfer a maximum of $2,000,000of Death only or Death and TPD cover. Any transferredcover will be added to your existing cover to the extentthe combined cover will not exceed the maximumcover levels.

The Insurer will assess your application and we willadvise you of the outcome in writing.

You will not be able to transfer your Previous Coverif:

you have made or are entitled to make a claimor are eligible to be paid a benefit in relation tothe Previous Cover; orthe Previous Cover has a premium loading; oryour Previous Cover is provided through aself-managed superannuation fund or anon-superannuation policy

If your Previous Cover is subject to a special conditionor exclusion, the condition or exclusion may continueto apply once the cover is transferred to Club PlusSuper.

How can I convert my unitised cover to fixedcover?

If you do not want your level of cover to change asyou get older, you can apply for fixed cover via theInsurance Variation form. By fixing your cover, theamount of your unitised cover will be converted to afixed amount rounded up to the nearest multiple of$1,000. With fixed cover, the amount of coverremains the same regardless of your age, but as youget older, the cost of cover generally increases.

You can switch between unitised and fixed cover atany time by completing the Insurance Variation form.If your application is accepted, the amount of yourunitised cover will be converted to fixed cover roundedup to the nearest $1,000, or fixed cover to unitisedcover.

Claiming a benefitDeath and Terminal Illness benefit

You will be entitled to a lump sum benefit if you dieor have a Terminal Illness whilst you are insured forDeath cover. The Terminal Illness benefit is anadvance payment of the Death benefit. So, if you arepaid a Terminal Illness benefit, any remaining amountof Death cover will be payable upon your death.

You will be considered to be suffering from a TerminalIllness if two Medical Practitioners provide writtencertification confirming that you suffer from an illnessor injury that, despite reasonable medicaltreatment, is likely to result in your death within 24months from the date of the written certification.Please also note that at least one of the MedicalPractitioners must be a Specialist MedicalPractitioner, and in some cases the insurer mayappoint one of the two Medical Practitioners. Pleaserefer to the Insurance Definitions for the full definitionof Terminal Illness.

The Terminal Illness Benefit becomes payable on theIncurred Date, and is equal to the lesser of:

the Death Benefit as at the date of the latestwritten certification from a Medical Practitioner;and$3,000,000.

If the amount of your Death cover is higher than$3,000,000, the benefit paid on your death will bereduced by the amount of the Terminal Illness benefitalready paid.

If Death cover is less than $3,000,000, your Deathand TPD cover will cease upon payment of a TerminalIllness Benefit by the Insurer.

TPD benefit

You will be entitled to a lump sum if, in the opinionof the Insurer, you meet the definition of Total andPermanent Disablement and provided you are insuredfor TPD cover as at the Event Date. The amount ofTPD benefit is the value of the number of units orfixed dollar cover allocated to your account as at theEvent Date. Please refer to the Insurance Definitionsfor the definitions of Total and PermanentDisablement and Event Date.

When will my claim not be paid?

No benefit is payable if the illness or injury resultingin your death, Terminal Illness or Total and PermanentDisablement is caused directly or indirectly, wholly or

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partially, from War or War Service occurring before orafter the date the Policy commenced. Please refer tothe Insurance Glossary for the definitions of War andWar Service.

If you submit a claim whilst you are outside Australia,the Insurer may require you to return to Australia (atyour own expense) for assessment of your claim. Thismay include attending a medical appointment. TheInsurer may waive this requirement where it issatisfied that you are unable to return to Australiadue to medical reasons.

If you have automatic cover, no benefit is payableunder automatic cover if the illness or injury resultingin your death, Terminal Illness or Total and PermanentDisablement is caused directly or indirectly, wholly orpartially, by a:

Deliberate Self-Inflicted Act, provided the dateof the Deliberate Self-Inflicted Act occurs within3 years of the date your automatic covercommences or increases; orPre-Existing Condition and the insured eventoccurs within the first 3 years of the date yourautomatic cover started or increased.

How do I claim a benefit?

If you (or your beneficiaries) wish to make a claim forany insured benefit provided by Club Plus Super, you(or your beneficiaries) need to contact Club PlusSuper. If you make a claim, you or your beneficiarieswill need to provide evidence that establishes yourentitlement to the benefit (at your own expenses),and we and/or the Insurer may conduct investigationsto assess the value and validity of your claim. Youmay be required to undertake avocational/employability assessment (for TPD claims)or be assessed by a Medical Practitioner appointedby the Insurer. The assessment may also involve theuse of investigation agents, legal advisers and thecollection of personal data that the Insurer believesis relevant.

For more information refer to the Death Claims factsheet or Insurance Claims fact sheet atclubplussuper.com.au/tools-resources/fact-sheets.

When cover starts and endsAm I eligible for cover?

You must be an Eligible Person to obtain any type ofcover under the Policy. Refer to the Eligibility sectionat the start of the booklet for more information.

To be eligible for automatic cover, you must alsosatisfy the conditions set out under Eligibility on thedate cover is due to commence or recommence (referto “When does cover start?”).

When does cover start?

Automatic cover starts on the date the Insurer acceptsyour Personal member special offer form in writing.

In all other circumstances, cover commences whenthe Insurer accepts your application for cover inwriting.

Interim Accident Cover

If you have applied for new or additional cover via thePersonal Statement form, cover will start from thedate the Insurer offers you cover in writing. You willreceive Interim Accident Cover (at no cost) while yourapplication is being assessed.

Under Interim Accident Cover, a benefit is payable ifyou die because of an Accident or an injury results inyour Total and Permanent Disablement because of anAccident, and provided your death or TPD Event Dateoccurs during the term of the Interim Accident Cover.Refer to the Insurance Definitions for the full definitionof Accident.

Interim Accident Cover starts from the date the Insureror we receive your application for cover and isavailable for up to a maximum of 60 days and willcease when your application has been accepted ordeclined by the insurer or withdrawn by you, you reachbenefit expiry age, or you cease to be a member ofClub Plus Super. You can only make a claim onceunder Interim Accident Cover.

Interim Accident Cover is based on the type and levelof cover or additional cover applied for (subject tomaximum of $1,000,000). For full details contact theClub Plus Super Member Hotline on 1800 680 627.

When does cover end?

Your Death and TPD cover will cease on the earliestof:

the date the Policy terminates;the date you reach the benefit expiry age whichat present is age 70 for Death and 60 for TPD;the date there is insufficient money in youraccount to cover the next premium payment;the date you commence active service with thearmed forces of any country (except where youare a member of the Defence Force Reserve,provided you are not subject to a call out order);

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if you are a member of the Defence ForceReserve, the date you become the subject of acall out order under the Defence Act 1903 (Cth);the date you cease to be a member of Club PlusSuper;the date you die;the date you are entitled to a TPD benefit;the date you are entitled to a Terminal Illnessbenefit for an amount equal to your level ofDeath cover (if your level of Death cover isgreater than the Terminal Illness benefit payable,the remaining amount of Death cover continues);the date we receive your request to cancel yourcover (written or over the phone) or the datespecified in your written request to cancel cover(whichever is later);the date the Insurer cancels or avoids your coveras permitted under law; andif you are not an Australian Resident, the dateyou are no longer eligible to work in Australia(be that because you no longer hold a Visa orfor any other reason), or the date Australiaceases to be your permanent place of residence.if you are not an Exempt Member**, the dateyour account becomes inactive which means nofunds have been attributed to your account (suchas a contribution or rollover) for 16 consecutivemonths and you have not elected to retain yourinsurance cover within the required timeframe*

*Where cover is cancelled and you have no cover onand from 2 July 2019, and you submit your requestfor reinstatement within 60 days of cover ceasing andyou are At Work on the date cover is torecommence, your cover may be reinstated from thedate cover last ceased without underwriting. If youare not At Work on the date your cover is torecommence, your cover will be Limited Cover untilyou have been At Work for 30 consecutive days.

**"Exempt Member" means a Member in respect ofwhom you are permitted to provide insurance coverunder section 68AAA of the Superannuation Industry(Supervision) Act 1993 (Cth) although no funds havebeen attributed to your account (such as acontribution or rollover) for 16 consecutive months.

If your cover ends, you may only be able torecommence cover by submitting an application forcover and being underwritten by the Insurer (unlessit ends involuntarily because of insufficient accountbalance, see “When does cover recommence?”).

When does cover recommence without requiringan application or without underwriting?

If your cover ends involuntarily due to an insufficientaccount balance to pay the insurance premium, yourcover will automatically recommence if you meet theeligibility criteria for cover and the followingrequirements are met:

a Contribution is made to your Club Plus Superaccount no more than 180 days after the endof the month in which your cover ended;you remained a member of Club Plus Super fromthe time cover ended until the time the requiredContribution is received; andyou have not previously cancelled your cover.

The type and level of cover you had immediately priorto it ceasing will recommence from the day the firstpremium payment is received by the Insurer.The following conditions will apply to recommencedcover:

the recommenced cover will have the sameconditions attaching to it as applied to the coverimmediately prior to it ending; andif you are Not At Work on the date coverrecommences, the recommenced cover will beLimited Cover. Limited Cover will be replacedwith Standard Cover on the date immediatelyafter you are At Work for two consecutive monthsafter cover recommences. Please refer to theinsurance definitions of At Work and LimitedCover.

Am I covered if I re-join Club Plus Super?

If you were previously an insured member of Club PlusSuper's Personal Division who applied under theSpecial Offer to receive automatic cover (as explainedunder Cover when you join Club Plus Super), you willnot be eligible to apply for automatic cover again ifyou re-join Club Plus Super's Personal Division. Youwill still be eligible to apply for cover by completing aPersonal Statement form and going throughunderwriting.If you re-join Club Plus Super's Industry Division, youmay be eligible to be accepted for automatic cover.Please refer to our Insurance Booklet Industry Divisionfor details on eligibility for cover on re-joining.

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Cost of coverThe premium rates that apply to unitised cover andfixed cover are set out in the tables below. On thelast Friday of each month, your insurance premiumsare deducted from your account and the premiumsare forwarded to the Insurer.

Unitised Cover Premium Scale

You pay a fixed amount for each unit. The followingtable shows the premium cost per week for a unit ofcover.

Death and TPD

($per unit perweek1)

TPD


Death


Age Band

(age nextbirthday)

$1.19$0.23$0.9616 - 20

$1.20$0.30$0.9021 - 30

$2.76$0.81$1.9531 - 45

$2.42$1.25$1.1746 - 55

$1.50$0.68$0.8256 and Over2

1 The cost of each unit of cover includes an additional amount,retained in the fund to cover the costs of administeringinsurance. The cost is 7 cents for Death units and TPD units,and 14 cents for Death and TPD units.

2 Death cover ceases when you turn 70. TPD cover ceases whenyou turn 60.

Fixed Cover Premium Scale

With fixed cover you choose the amount of Death &TPD insurance cover you require and the cost iscalculated based on your age next birthday and yourlevel of cover. The table below sets out the weeklycost of each $1,000 of cover. From the date you turn60, you will no longer have a TPD benefit.

Weekly premium rates per $1,000 of coverAge nextbirthday Death and TPD($)TPD ($)Death ($)

$0.02380$0.00460$0.0192016 - 20

$0.02400$0.00600$0.0180021

$0.02365$0.00600$0.0176522

$0.02331$0.00600$0.0173123

$0.02298$0.00600$0.0169824

$0.02236$0.00600$0.0163625

$0.02100$0.00600$0.0150026

$0.01985$0.00600$0.0138527

$0.01800$0.00600$0.0120028

$0.01623$0.00600$0.0102329

$0.01500$0.00600$0.0090030

$0.03393$0.01620$0.0177331

$0.03273$0.01620$0.0165332

$0.03180$0.01620$0.0156033

$0.03120$0.01620$0.0150034

$0.03103$0.01620$0.0148335 - 40

$0.03136$0.01653$0.0148341

$0.03206$0.01723$0.0148342

$0.03283$0.01800$0.0148343

$0.03601$0.01976$0.0162544

$0.04023$0.02250$0.0177345

$0.05467$0.04167$0.0130046

$0.07158$0.05208$0.0195047

$0.08813$0.05952$0.0286148

$0.09912$0.06579$0.0333349

$0.11360$0.07353$0.0400750

$0.12782$0.08333$0.0444951

$0.14615$0.09615$0.0500052

$0.16124$0.10417$0.0570753

$0.18050$0.11364$0.0668654

$0.22250$0.12500$0.0975055

$0.15756$0.07556$0.0820056

$0.16700$0.08500$0.0820057

$0.17914$0.09714$0.0820058

$0.19533$0.11333$0.0820059

$0.21800$0.13600$0.0820060

N/A1N/A$0.1093361 - 70

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1 When you turn 60 you will no longer be eligible for a TPD benefitand your cover will revert to Death only cover.

EXAMPLE*

James, aged 41, requires $500,000 worth of FixedDeath and TPD insurance cover. James uses therate for the age at his next birthday to calculatethe cost of cover. Death and TPD calculation =$500,000/$1,000 x 0.03206 = $16.03 per week

*This example is for illustrative purposes only.

Insurance DefinitionsCapitalised words and expressions used throughoutthis Booklet have special definitions. The definitionsare as stated in our Insurance Policies. We have setout many of the key definitions from the InsurancePolicies below. Please refer to the Insurance Policiesfor the definitions of any terms which have specialmeanings that are not set out below.

Accident

means:

a fortuitous, external event which was unexpectedand unintended causing death or total and permanentdisablement (as the context so requires).

Events that are not accidents

The following situations are not accidents, and anyclaims arising from these situations are excluded:

a any one or more of the following was acontributing cause of injury or death:

pre-Existing Condition;sickness or illness;disease;allergy; orany gradual onset of a physical or mentalinfirmity;

b the injury or death was the result of aDeliberate Self-Inflicted Act or omission of theinsured member; and

c the insured member was injured or died as aresult of an activity in respect of which theyassumed the risk or courted disaster,irrespective of whether they intended injuryor death.

Active Employment

means you are Gainfully Working and:

a in the insurer's opinion, actively performingall the duties of your occupation, free fromany limitation due to illness or injury and noton leave; or

b on Employer Approved Leave, or self-employedand on leave, taken for reasons unrelated toinjury or illness, and in the insurer's opinion,capable of actively performing all the dutiesof your occupation (being the occupationperformed by you when you last worked), free

11

from any limitation due to illness or injury,and

c are capable of performing all the duties ofyour occupation on a Full-time basis (even ifnot working Full-time).

Activities of Daily Living

means:

a Dressing – the ability to put on and take offclothing;

b Toileting - the ability to use a toilet, includinggetting on and off;

c Mobility - mobility, to the extent of being ableto get in and out of bed or a chair;

d Continence – the ability to control bowel andbladder function;

e Feeding – the ability to get food from a plateinto the mouth,

without the assistance of another adult person orsuitable aids.

Activities of Daily Work

means:

a Bending – The ability to bend, kneel or squatto pick something up from the floor andstraighten up again.

b Communicating – the ability to:

clearly hear with or without a hearing aid oralternative aid if required;comprehend and express oneself by spoken orwritten language with clarity; andinteract with others by listening, comprehendingand speaking on a day to day basis and in awork environment.

c Vision (reading) – the ability to read, with orwithout correction with suitable lenses, to theextent that an ophthalmologist can certifythat:

visual acuity is equal to, or better than, 6/48 inboth eyes; orconstriction is within or greater than 20 degreesof fixation in the eye with the better vision.

d Walking – the ability to walk more than 200mon a level surface without stopping due tobreathlessness, angina or severe painelsewhere in the body.

e Lifting – the ability to lift, carry or otherwisemove objects weighing up to 5kg using oneor both hands.

f Manual Dexterity – the ability, with reasonableprecision and success, to:

use at least one hand, its thumb and fingers,including the ability to pick up and manipulatesmall objects; anduse a keyboard.

At Work

means you are an Eligible Person & Gainfully Working;and

a are:

in the Insurer’s opinion, actively performing allthe duties of your occupation, free from anylimitation due to illness or injury and not onleave; oron Employer Approved Leave, or self-employedand on leave, taken for reasons unrelated toinjury or illness, and in the Insurer’s opinion,capable of actively performing all the duties ofyour occupation (being the occupation performedby you when you last worked), free from anylimitation due to illness or injury, and

b are capable of performing all the duties ofyour occupation on a Full-time basis (even ifnot working Full-time); and

c are not in receipt of, or entitled to claim,income support benefits from any sourceincluding but not limited to workers’compensation benefits, statutory motoraccident benefits or disability income benefits(including government income supportbenefits of any kind).

An Eligible Person who does not meet theserequirements is correspondingly described as Not AtWork.

Australian Resident

means an Australian citizen, a New Zealand citizenor an ‘Australian permanent resident’ within themeaning of the Migration Act 1958 (Cth) and MigrationRegulations 1994 (Cth).

Claiming Member

means a person who:

a had a claim admitted;b is eligible to receive a benefit;

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c is in a Waiting Period for a benefit; ord is in the process of claiming a benefit;

for terminal illness of total and permanentdisablement from you under any policy issued by anyinsurer, or from another superannuation fund or lifeinsurance policy on or before the start date of theautomatic cover.

Date of Disablement

means:

a except for TPD Definition 2 and TPD Definition4, the first day that all of the elements of thedefinition are satisfied; or

b for TPD Definition 2 and TPD Definition 4, thefirst day after the expiry of the Waiting Period.

Defence Force Reserve

means the Australian army, naval or air forcereserves.

Deliberate Self-Inflicted Act

means a deliberate self-inflicted act of the insuredmember, including but not limited to attemptedsuicide or suicide, whether or not the person is saneat the time.

Eligible Person

a is a Member; andb is either

i. an Australian Resident residing in oroutside Australia; or

ii. a holder of a Visa residing inAustralia; and

c is aged at least 15 years and not older thanthe Maximum Benefit Entry Age

on the date their Cover is due to commence orrecommence.

Employer Approved Leave

means a person is:

a employed or self-employed for reward orfinancial benefit, or the hope of reward orfinancial benefit, in any business, trade,profession, vocation, calling, occupation oremployment; and

b on leave that has been approved by theperson’s employer prior to thecommencement of that leave (except forapproved sick leave).

Event Date

means in relation to an insured member:

a for TPD Definition 1, the date the insuredmember suffers the total and permanent lossof the use of two limbs (where ‘limb is definedas the whole hand or the whole foot), thesight in both eyes, or the sight in one eye andthe use of one limb;

b for TPD Definition 2, the first day of theWaiting Period during which the insuredmember, in the Insurer’s opinion, solelybecause of injury or illness, has not worked;

c for TPD Definition 3, the first day the insuredmember in the Insurer’s opinion, solelybecause of injury or illness, is totally andirreversibly unable to perform at least two ofthe Activities of Daily Living;

d for TPD Definition 4, the first day of theWaiting Period during which the insuredmember, in the Insurer’s opinion, solelybecause of injury or illness, is unable toperform Normal Domestic Duties; or

e for TPD Definition 5, the first day the insuredmember in the Insurer’s opinion, solelybecause of injury or illness, is totally andirreversibly unable to perform at least four ofthe Activities of Daily Work.

Following The Advice Of A Medical Practitioner

means the insured member is under the regular careand following the regular advice of their treatingMedical Practitioner on an ongoing basis, includingfollowing all recommended courses of treatment andrehabilitation.

Full-time

means a person is working at least 35 hours perweek.

Gainful Employment

means any occupation or work for reward or financialbenefit, or the hope of reward of financial benefit,whether on a permanent or temporary basis, andwhether or not of a lesser grade, status or level ofremuneration or for lesser hours than the insuredmember’s occupation or occupations or work.

Gainfully Working

means a person is:

a employed or self-employed for reward orfinancial benefit, or the hope of reward or

13

financial benefit, in any business, trade,profession, vocation, calling, occupation oremployment; or

b on Employer Approved Leave.

Home

means the Insured Member’s principal place ofresidence.

Limited Cover

means an Insured Member will only be covered forDeath and Total and Permanent Disablement (asapplicable) which does not arise either directly orindirectly, wholly or partially, from a Pre-ExistingCondition of the insured member.

Medical Consultation

means any activity undertaken for the detection,treatment or management of an illness, injury,medical condition or related symptom, including butnot limited to the application of prescribed drugs ortherapy (whether conventional or alternative).

Normal Domestic Duties

means the tasks performed by the Insured Memberwhose sole occupation is to maintain their familyHome. These tasks are:

cleaning of the Home;cooking of meals for the family;doing their family’s laundry;shopping for their family’s food; andtaking care of dependent children (whereapplicable).

Normal Domestic Duties do not include dutiesperformed outside the Insured Member’s Home forsalary, reward or profit.

Pre-Existing Condition

means an injury, illness, condition or relatedsymptom, whether it was diagnosed by a MedicalPractitioner or not, which in the Insurer’s opinion:

a the Insured Member (or a reasonable personin their position) was aware of, or should havebeen aware of;

b the Insured Member had, or was intending tohave, a Medical Consultation; or

c a reasonable person in the circumstances ofthe Insured Member would have had aMedical Consultation,

as at or prior to the date cover commenced,recommenced or increased (with respect to theincreased Insured Amount of Cover only).

Previous Education, Training or Experience

means any education, training or experience theperson has undertaken prior to the Event Date.

14


Reasonable Retraining or Rehabilitation

means:

a any further education, training, experience orrehabilitation the person has undertakensince the Event Date; or

b any further education, training, experience orrehabilitation the person, in our opinion, hascapacity to undertake and can be reasonablyexpected to do based on their PreviousEducation, Training Or Experience.

Terminally Ill or Terminal Illness

means an illness or injury where all of the following(a), (b), (c), (d) and (e) are satisfied in respect of anInsured Member:

a two Medical Practitioners certify in writing(“Written Certification”) that the InsuredMember suffers from an illness or hasincurred an injury that, despite reasonablemedical treatment, is likely to result in theInsured Member’s death within 24 monthsfrom the date of Written Certification(“Certification Period”);

b the Insurer is satisfied from medical or otherevidence that the Insured Member will,despite reasonable medical treatment, diefrom the illness or injury within theCertification Period;

c at least one of the Medical Practitioners is aSpecialist Medical Practitioner, and one ofwhich may be appointed by the Insurer;

d for each Written Certification, the CertificationPeriod has not ended; and

e the Written Certification by both MedicalPractitioners must be dated during the periodthe Insured Member is insured for DeathCover under the Policy.

Total and Permanently Disabled, Total andPermanent Disablement, Totally and PermanentDisability and TPD

TPD Definition 1

In the Insurer’s opinion based on medical or otherevidence satisfactory to the Insurer, solely becauseof injury or illness, the Insured Member:

a suffers the total and permanent loss of theuse of:

i. two limbs (where ‘limb’ is defined as thewhole hand or the whole foot); or

ii. the sight in both eyes; oriii. one limb and the sight in one eye; and

b as at the Date of Disablement, is incapableof ever working in any Gainful Employment forwhich he or she:

i. is reasonably suited by Previous Education,Training or Experience; or

ii. may become reasonably suited due toReasonable Retraining or Rehabilitation.

Or

TPD Definition 2

An Insured Member:

a is Following The Advice Of A MedicalPractitioner in relation to their illness or injuryfor which they are claiming;

b is Gainfully Working at any time during the 12consecutive months immediately prior to theEvent Date; and

c in the Insurer’s opinion based on medical orother evidence satisfactory to the Insurer,solely because of injury or illness, the InsuredMember:

i. has not worked during the entire WaitingPeriod;

ii. as at the Date of Disablement is incapableof ever working in any Gainful Employment forwhich he or she:

A is reasonably suited by Previous Education,Training or Experience; or

B may become reasonably suited due toReasonable Retraining or Rehabilitation.

Or

15

TPD Definition 3


a is totally and irreversibly unable to perform atleast two of the Activities of Daily Living; and

b as at the Date of Disablement is incapableof ever working in any Gainful Employment forwhich he or she:

i. is reasonably suited by Previous Education,Training or Experience; or

ii. may become reasonably suited due toReasonable Retraining or Rehabilitation

Or

TPD Definition 4

An Insured Member:

a is not Gainfully Working at any time during the12 consecutive months immediately prior tothe Event Date;

b is capable of performing Normal DomesticDuties (even if not actually performing suchduties) during the entire 12 consecutivemonths immediately prior to the Event Date;and

c in the Insurer’s opinion based on medical orother evidence satisfactory to the Insurer,solely because of injury or illness, the InsuredMember:

i. is Following The Advice Of A MedicalPractitioner in relation to their illness or injuryfor which they are claiming; and

ii. is unable to perform Normal Domestic Dutiesduring the entire Waiting Period; and

iii. as at the Date of Disablement:

A. is unlikely ever to perform any Normal DomesticDuties;

B. is incapable of ever working in any GainfulEmployment for which he or she:

is reasonably suited by Previous Education,Training Or Experience; ormay become reasonably suited due toReasonable Retraining or Rehabilitation;

C. is totally and irreversibly unable to leave their homeunaided.

Or

TPD Definition 5


a is under the regular care of a MedicalPractitioner;

b is totally and irreversibly unable to perform atleast four of the Activities of Daily Work; and

c as at the Date of Disablement:

i. is likely to require the ongoing care of aMedical Practitioner; and

ii. is incapable of ever working in any GainfulEmployment for which he or she:

A. is reasonably suited by Previous Education,Training or Experience; or

B. may become reasonably suited due toReasonable Retraining or Rehabilitation.

In determining if the Insured Member satisfies TPDDefinitions 1 – 5, the Insurer may have regard to allrelevant information available to us from the EventDate. This includes information relevant to the InsuredMember’s future capability to return to work.

Any factors unrelated to the Insured Member’scapability, solely because of injury or illness, will notbe considered. These include external factors suchas availability of work and geographical location aswell as the personal circumstances of the InsuredMember such as their length of time out of theworkforce or any other factors which may be relevantto the likelihood of the Insured Member returning towork.

Visa

means a current and valid visa permitting residency(excluding a visa which allows permanent residencyin Australia) or employment in Australia and issuedin accordance with the Migration Act 1958 (Cth) orany amending or replacing act, including but notlimited to sub class 457 working visa or sub class457 working visa (with an 8107 condition).

Waiting Period

means:

a for TPD Definition 2, a 91 consecutive dayperiod;

b for TPD Definition 4, a 183 consecutive dayperiod.

16


War

includes, but is not limited to declared war, and armedaggression by one or more countries resisted by anycountry, combination of countries or internationalorganisations.

War Service

includes, but is not limited to participation in an actionto defend a country or region from civil disturbanceor insurrection, or in an effort to maintain peace.

Other defined terms

Refer to the relevant insurance policy for theremaining defined terms.

17

Cover when you join Club Plus Super

EligibilityYou must be an Eligible Person to obtain any type ofcover under the Policy. A person is eligible for coverif the person:

joins Club Plus Super personally (i.e. not throughan employer who pays their superannuationcontributions to Club Plus Super) and they areself-employed or their employer won’t registerwith Club Plus Super;aged at least 15 years; andis either an Australian Resident, or a holder ofa Visa residing in Australia; andnot older than the Maximum Benefit Entry Agewhich at present is 59 years,

on the date cover is due to commence orrecommence.

To be eligible for automatic cover, in addition to theabove eligibility requirements, you must not havepreviously received automatic cover in relation to thesame account or previous account (including exitedaccounts) in Club Plus Super. If you have previouslyobtained automatic cover, you can only obtain coverby applying for cover via the Personal Statement formand being underwritten by the Insurer.

If you are applying for cover or additional cover viathe Personal Statement form, you must be workingin an occupation for which cover is available underthe policy, and cover is subject to Insurer'sacceptance.

What type of cover can I apply for without havingto provide health information?

When you first join the Personal Division of Club PlusSuper, you may be eligible to apply for Short TermIncome Protection (IP) cover, without having to bemedically assessed by the Insurer (“automaticcover”). In the event you are Totally Disabled orPartially Disabled which prevents you from working,Short Term IP cover provides you with a monthlybenefit for up to 24 months. This new member offerwill be made within your Welcome Letter, when ClubPlus Super advises you of your membership number.To apply, you must return the Personal memberspecial offer form to us within 60 days of the date ofthe Welcome Letter. If we receive the Personalmember special offer form after the 60 days, you willnot be eligible for the new member offer and you will

need to apply for insurance cover by completing thePersonal Statement at the end of this booklet. Youcan only take up this offer once when you join ClubPlus Super.

Health evidence is not required for automatic cover,however any automatic cover provided is subject toa 3-year Pre-Existing Condition exclusion. Please referto “When will my claim not be paid?” for details aboutthe exclusion that applies to your automatic cover.Your cover will continue to be subject to thePre-Existing Condition exclusion until the Insurerapproves an application to have the exclusionremoved. You can make such an application bycompleting the Personal Statement form at the endof this booklet and being underwritten by the Insurer.

How much cover can I apply for without havingto provide health information?

Automatic cover pays you a monthly benefit of up to90% of your Pre-Disability Salary plus a SuperContribution Benefit of 9.5% of your Pre-DisabilitySalary, subject to a maximum of $5,000 per month.

Benefits are payable after a waiting period of 21 days.Your Pre-Disability Salary is determined by calculatingyour average monthly value of salary from your usualoccupation over the last 12 months or the actualperiod of time the Insured Member worked if lessthan 12 months (provided the period of work occurredin the 12 month period preceding the Date ofDisablement and subject to a minimum averagingperiod of 6 months). If you have worked less than 6months, the Salary received for any full-month notworked will be zero prior to the Date of Disablement.

Please refer to the Insurance Definitions for the fulldefinition of Pre-Disability Salary.

What is the cost of automatic cover?

The cost of automatic cover equals 1.04% of yourSalary.

The cost of automatic cover includes an amount of0.2% which is retained in the fund to cover the costsof administering insurance in the Fund.

Changing your coverHow can I change my cover, or obtain cover, afterI join?

You have the option to increase the Waiting Periodthat applies to your Short Term IP cover by completingthe Insurance Variation form. The optional waiting

18


periods include 45 days and 90 days. Reducedpremium rates apply under the extended waitingperiods.

If you take up an optional waiting period, and laterwish to reduce the waiting period, you must completethe Personal Statement form and need to beunderwritten by the Insurer. The Insurer will need toaccept your application.

Additional or new cover can be applied for at any time,but you will need to complete the Personal Statementform (available at the back of this booklet) and beunderwritten by the Insurer. The Insurer will need toaccept your application.

You can apply for up to a monthly benefit of 90% ofyour Salary (plus the Superannuation ContributionBenefit of up to 9.5% of your Pre-Disability Salary),subject to a maximum of $30,000 per month. Themaximum benefit payable per month under Short TermCover is always limited to the lesser of:

$5,000 (inclusive of the Super ContributionBenefit) if you only have automatic cover; or$30,000 (inclusive of the Super ContributionBenefit) if you have been underwritten for andreceived additional cover; or90% of your Pre-Disability Salary plus the SuperContribution Benefit.

Long Term Income Protection Cover

You also have the option to apply for Long TermCover, which pays you ongoing monthly benefits upto age 65 after a two-year Waiting Period,complementing your Short Term Cover subject toPolicy terms and conditions. The application will besubject to approval by the Insurer and will go throughthe underwriting process. Under Long Term Cover,you can receive a monthly benefit of up to 75% ofyour Pre- Disability Salary plus the Super ContributionBenefit of up to 9.5% of your Pre-Disability Salary,subject to a maximum of $30,000 per month.

If you have been receiving a benefit under Long TermCover for 12 consecutive months, the amount of thebenefit will increase by the lesser of the annualConsumer Price Index and 5% per annum (subjectalways to the maximum benefit of $30,000 permonth). This increase will apply upon the expiry ofeach 12-month period that a benefit is continuouslypaid to you. After the expiry of the period that you areentitled to receive income protection benefits, thebenefit reverts to the amount that applied before youwent on claim.

You can have Long Term Income Protection coverwithout Short Term Income Protection or can you havea combination of both.

To apply for Long Term Cover, please complete thePersonal Statement at the back of this booklet.

The maximum benefit payable under Long Term IPcover is at all times equal to the lesser of:

$30,000; and75% of your Pre-Disability Salary plus the SuperContribution Benefit.

Can I transfer cover from another fund to ClubPlus Super?

If you have IP cover through another superannuationfund (other than a self-managed super fund) you maybe able to transfer that cover ("Previous Cover") toClub Plus Super by completing the Insurance TransferForm if your form is accepted by the insurer.

You can apply to transfer up to the maximum of$30,000 per month of IP cover subject to the totalamount of cover not exceeding the maximum benefitlimit of $30,000 per month and the transferred coverwill replace any existing IP cover you hold with ClubPlus Super.

The Insurer will assess your application and we willadvise you of the outcome in writing.

You will not be able to Transfer your Previous Coverif:

you have made or are entitled to make a claimor are eligible to be paid a benefit in relation tothe Previous Cover; orthe Previous Cover has a premium loading.

If your Previous Cover is subject to a special conditionor exclusion, the condition or exclusion will continueto apply once the cover is transferred to Club PlusSuper.

19

Claiming a benefitWhen am I eligible to claim a benefit?

A benefit for Total Disability or Partial Disability is onlypayable if:

your IP cover has not ended as at the Date ofDisablement;you are Gainfully Working on the day immediatelybefore the Date of Disablement;you have been Totally Disabled for at least 14days out of the first 19 consecutive days of theWaiting Period; you have been Totally Disabled or PartiallyDisabled for the remainder of the Waiting Period;andeither:

1. Totally disabled immediately after the end ofthe Waiting Period; or

2. Partially Disabled immediately after the endof the Waiting Period, and then TotallyDisabled immediately after ceasing to bePartially Disabled, due to the same or relatedcause; and

3. The waiting period has expired

You can claim a Total Disability Benefit if you satisfythe definition of Totally Disabled.

You may be able to claim a Partial Disability Benefitif you return to work in a reduced capacity and yousatisfy the definition of Partially Disabled. Please referto the Insurance definitions of Totally Disabled,Partially Disabled, Gainfully Working and Date ofDisablement.

The Partial Disability Benefit is calculated as follows:

(A - B) x C A

Where:

A is your Pre-Disability Salary;

B means the greater of:

the monthly value of the Salary that you areearning; andthe monthly income which in the Insurer’sopinion you are capable of earning, during themonth that you are entitled to a Partial DisabilityBenefit;

C means the monthly benefit which would be payableif you were Totally Disabled.

You can only be paid for one Income Protection claimat any one time, even if you suffer from more thanone illness or injury.

What is the Super Contribution Benefit?

While you are receiving a Total Disability Benefit,Superannuation Guarantee contributions of 9.5% ofyour Pre-Disability Salary will be paid directly into yourClub Plus Super account on your behalf. If you arereceiving a Partial Disability Benefit, the Super

Contribution Benefit will be reduced on a pro ratabasis proportionate to the amount of the PartialDisability Benefit payable during the relevant month.

When do benefit payments commence?

Benefits are payable monthly in arrears after the endof the relevant waiting period. The waiting periodstarts on the later of:

the day you become Totally Disabled;the day you consult a Medical Practitioner andreceive medical certification confirming that youare:

i. incapable of performing one or more dutiesof your Usual Occupation necessary to produceSalary; and

ii. Following The Advice Of A MedicalPractitioner in relation to the injury or illnessfor which you are claiming; and

the day after you stop working, provided this dayis after your cover started with Club Plus Super.

If you return to work during the waiting period, thewaiting period starts again. However, if you return towork, once performing your usual duties and workingfor up to 5 consecutive days, the waiting period willnot recommence but those days of work will be addedto the waiting period. Please refer to the InsuranceDefinitions.

When do benefit payments end?

Benefits will end on the earliest of the followingevents:

The end of the Benefit Period – under Short TermCover the benefit period is 2 years and underLong Term Cover the benefit period is to age 65;You are no longer Totally Disabled (applies toTotal Disability Benefits);You are no longer Partially Disabled (applies toPartial Disability Benefits);When you die;

20


You reach the Benefit Expiry Age, which is 70years under Short Term Cover and 65 yearsunder Long Term Cover;the expiry of 6 consecutive months after youdepart Australia where you have remainedoutside Australia for the entire 6 consecutivemonths and a Total Disability Benefit or PartialDisability Benefit has been paid or is payablefor those 6 months; andthe date your fixed term contract of employmentexpires if, as at the Date of Disablement, youwere employed for a fixed term (as a contractoror otherwise).

When will my Total or Partial Disability benefitbe reduced?

The amount of your Total Disability Benefit or PartialDisability Benefit will be reduced by the followingpayments made for the purpose of replacing loss ofincome due to illness or injury:

payments from any other disability income,illness or injury policies including groupinsurance policies or from a superannuationfund;payments from an employer whilst you are onclaim including sick leave but excluding annualleave, long service leave, termination paymentsand paid parental leave; and/orpayments from any compulsory insuranceschemes such as Workers’ Compensation orAccident Compensation or similar legislation orcommon law for loss of income, but not includingCentrelink or its successors.

The amount of your Super Contribution Benefit willbe reduced by any contribution paid or payable byanother insurer or any compulsory insurance schemessuch as Workers’ Compensation or AccidentCompensation referable to a period that you are OnClaim, but only to the extent that the contribution ismade to replace in whole or in part the compulsoryemployer superannuation entitlements you would havebenefit from had you not been Totally Disabled orPartially Disabled.

When will my claim be denied?

No benefit is payable if the illness or injury resultingin your Total Disability or Partial Disability is causeddirectly or indirectly, wholly or partially, from any ofthe following:

War or War Service occurring before or after thedate the Policy commenced;

You becoming pregnant, giving birth ormiscarrying. However, if you are continuouslyTotally Disabled or Partially Disabled for morethan 90 day after your pregnancy ends, you willbe eligible to claim a benefit from the end of the90 days period (or after the expiry of the waitingperiod, if later); orYour Deliberate Self-Inflicted Act.

Refer to the Policy for the full list of exclusions.

No benefit will be paid where you suffer TotalDisability or Partial Disability whilst imprisoned or thesubject of a custodial sentence as a consequence ofbeing convicted or committing a criminal offence.

If you have automatic cover, no benefit is payableunder automatic cover if your Total Disability or PartialDisability is caused wholly or partially, directly orindirectly, by a Pre-Existing Condition and the TotalDisability or Partial Disability occurs within 3 years ofthe date your automatic cover commences.

What if my disability recurs after I return to work?

If you have been on claim and you return to full-timework (where you worked full-time before your claim),or your return to full-time or part-time work (where youworked part-time before your claim) or you return toeither full-time or part-time work and are earning, orin the insurer's opinion you are capable of earning,a monthly Salary that is equal to or greater than yourPre-Disability Salary, and within six months of youroriginal claim ending, you become Totally Disabled orPartially Disabled as a result of the same or relatedillness or injury which was the cause of the originalclaim, you can lodge a further claim in respect of thesame or related illness or injury (recurrent claims). TheInsurer will treat your recurrent claim as a continuationof your original claim and the waiting period andbenefit period will not start again. This means therecurrent claim is part of the same benefit period asthe original claim, and the insurer will only pay thebenefit for the remaining benefit period.

If your disability recurs more than 6 months after yourclaim ended, any further claim will be treated as anew claim and the waiting period and benefit periodwill recommence.

How do I claim a benefit?

It is important to notify us of your intention to makea claim as soon as it is reasonably possible for youto do so.

21

Every claim for a benefit under the Policy must bemade in the form prescribed by the Insurer and shallbe accompanied by such evidence including but notlimited to proof of your identity, medical reports fromyour treating doctors, financial information andongoing claim forms, as required by the Insurer. Theclaim forms are available by calling 1800 680 627.

Other important information

You are not entitled to a benefit until the Insurer hasassessed the claim and agreed that a benefit shouldbe payable under the Policy. All certificates andevidence required by the Insurer to assess your claimmust be provided at your own expense.

If you submit a claim whilst you are outside Australia,the Insurer may require you to return to Australia (atyour own expense) for assessment of your claim. Thismay include attending a medical appointment. TheInsurer may waive this requirement where it issatisfied that you are unable to return to Australiadue to medical reasons.

When we will waive the premium

The insurer will waive your Income Protectionpremiums which would otherwise be due whilst youare receiving the Total Disability Benefit or PartialDisability Benefit.

When cover starts and ends

Am I eligible for cover?Refer to the Eligibility section at the start of theIncome Protection section for details on covereligibility.

When does cover start?

Automatic cover starts on the date the Insurer acceptsyour Personal member special offer application formin writing.

In all other circumstances, cover commences whenthe Insurer accepts your application for cover inwriting.

When does cover end?

Your Income Protection cover will cease on theearliest of:

the date the Policy terminates;the date you reach the cover expiry age whichis 70 years under Short Term Cover and 65years under Long Term Cover;the date there is insufficient money in youraccount to cover the next premium payment;the date you commence active service with thearmed forces of any country (except where youare a member of the Defence Force Reserve,provided you are not subject to a call out order);the date you become the subject of a call outorder under the Defence Act 1903 (Cth);the date you cease to be a member of Club PlusSuper;the date you die;the date we receive your request to cancel yourcover (written or over the phone) or the datespecified in your written request to cancel cover(whichever is later);the date the Insurer cancels or avoids your coveras permitted under law; andif you are not an Australian Resident, the dateyou are no longer eligible to work in Australia(be that because you no longer hold a Visa orfor any other reason), or the date Australiaceases to be your permanent place of residence.If you are not an Exempt Member** the dateyour account becomes inactive which means nofunds have been attributed to your account (suchas a contribution or rollover) for 16 consecutivemonths and you have not elected to retain yourinsurance cover within the required timeframe*.

22


*Where cover is cancelled and you have no cover onand from 2 July 2019, and you submit your requestfor reinstatement within 60 days of cover ceasing andyou are At Work on the date cover is to recommence,your cover may be reinstated from the date cover lastceased without underwriting. If you are not At Workon the date your cover is to recommence, your coverwill be Limited Cover until you have been At Work for30 consecutive days.

**"Exempt Member" means a Member in respect ofwhom you are permitted to provide insurance coverunder section 68AAA of the Superannuation Industry(Supervision) Act 1993 (Cth) although no funds havebeen attributed to your account (such as acontribution or rollover) for 16 consecutive months.

If your cover ends, you may only be able torecommence cover by submitting an application forcover and being underwritten by the Insurer (unlessit ends involuntarily because of insufficient accountbalance).

What happens if I change jobs - does my covercontinue?

Yes, if you are an insured member and change jobsor employers, your cover continues, unless you cancelit.

If you do not have cover and start working for anEmployer (that makes employer contributions to ClubPlus Super on your behalf), you may be automaticallyaccepted for cover as a member of the IndustryDivision. Please refer to the Industry DivisionInsurance Booklet for details.

Am I covered if I re-join Club Plus Super?

If you were previously an insured member of Club PlusSuper's Personal Division who applied under the newmember offer to receive automatic cover (as explainedunder Eligibility), you will not be eligible to apply forautomatic cover again if you re-join Club Plus Super'sPersonal Division. You will still be eligible to apply forcover by completing a Personal Statement form andgoing through underwriting.If you re-join Club Plus Super's Industry Division, youmay be eligible to be accepted for automatic cover.Please refer to our Industry Division Insurance Bookletfor details on eligibility for cover on re-joining.

Cost of cover - Short Term Income Protection

The premium rates are set out in the tables below.

Premiums are based on the relevant waiting period,and are calculated as a percentage of your insuredannual salary and deducted monthly.

Premium Rates are a % of Insured Salary

904521Waiting Period (Days)

222Benefit Period(Years)

0.62%0.91%1.04%Premium Rates

23

Long Term Income Protection - Cost of cover

Premiums are based on your gender, your age nextbirthday and monthly benefit. Long Term Cover isbased on the benefit period of 'to age 65', subjectto 2 year waiting period.

Weekly Premium Rates per $100 ofmonthly Cover

Age Next Birthday

FemaleMale

0.07810.07316 - 20

0.0780.073221

0.07940.070622

0.08090.067823

0.08220.06624

0.08370.064125

0.08560.063126

0.09040.062227

0.0950.063128

0.09930.063229

0.10370.064630

0.10820.066431

0.11380.06932

0.11930.07233

0.12640.075634

0.13440.0835

0.14430.085436

0.15590.091837

0.16960.098738

0.18550.107239

0.20410.11740

0.22530.128341

0.250.141142

0.27730.156143

0.30820.172644

0.34140.191145

0.37780.212546

0.41640.236247

0.45720.262448

0.4990.290849

0.54180.321850

0.57270.355351

0.60160.390852

0.62690.428353

0.64790.467654

0.66470.508155

0.66190.549156

0.65210.587957

0.63340.62358

0.59460.639359

0.54750.643860

0.49170.57161

0.42590.541162

0.35940.486963

N/AN/A64 - 65

EXAMPLE*

Jake will be 22 years old on his next birthday andearns $60,000 per year ($5,000 per month).Under Long Term Income Protection insurance hecan be covered for up to 75% of income ($45,000per year or $3,750 per month) plus SGcontributions of $5,700 per year (or $475 permonth). Therefore his total monthly benefit is$4,225.The premium states ‘weekly premium rate per$100 of monthly benefit’. Therefore the calculationwill be based on the total monthly benefit of$4,225 (75% of salary plus SG).The calculation is $4,225/100 x 0.0706 = $2.98per week.

21Insurance booklet - Industry division - October 2017

*This example is for illustrative purposes only.

Age next birthday

Voluntary Long Term - 2 year

Male Female

16 0.0730 0.078117 0.0730 0.078118 0.0730 0.078119 0.0730 0.078120 0.0730 0.078121 0.0732 0.078022 0.0706 0.079423 0.0678 0.080924 0.0660 0.082225 0.0641 0.083726 0.0631 0.085627 0.0622 0.090428 0.0631 0.095029 0.0632 0.099330 0.0646 0.103731 0.0664 0.108232 0.0690 0.113833 0.0720 0.119334 0.0756 0.126435 0.0800 0.134436 0.0854 0.144337 0.0918 0.155938 0.0987 0.169639 0.1072 0.185540 0.1170 0.204141 0.1283 0.225342 0.1411 0.250043 0.1561 0.277344 0.1726 0.308245 0.1911 0.341446 0.2125 0.377847 0.2362 0.416448 0.2624 0.457249 0.2908 0.499050 0.3218 0.541851 0.3553 0.572752 0.3908 0.601653 0.4283 0.626954 0.4676 0.647955 0.5081 0.664756 0.5491 0.661957 0.5879 0.652158 0.6230 0.633459 0.6393 0.594660 0.6438 0.547561 0.5710 0.491762 0.5411 0.425963 0.4869 0.359464 NA NA65 NA NA

Long Term Cover

The table (to the left) shows the cost of Long Term Cover based on a two year waiting period, your age and sum insured. The premium is expressed in the form of fi xed cover units in $100 per week benefi t multiples.

EXAMPLE*

Jake will be 22 years old on his next birthday and earns $60,000 per year ($5,000 per month). Under Long Term Income Protection insurance he can be covered for up to 75% of income ($45,000 per year or $3,750 per month) plus SG contributions of $5,700 per year (or $475 per month). Therefore his total monthly benefi t is $4,225.

The premium states ‘weekly premium rate per $100 of monthly benefi t’. Therefore the calculation will be based on the total monthly benefi t of $4,225 (75% of salary plus SG).

The calculation is $4,225/100 x 0.0706 = $2.98 per week.

24


Transferring between divisionsIf an Insured Member in the Personal Divisioncommences work with a Contributing Employer afterthe person became an Insured Member in thePersonal Division, the person may be transferred toIndustry Division of the Fund. This is at the discretionof the Trustee. A member will be notified upon transferto the Industry Division. If a member is transferred,the following terms apply to the Insured Member'sCover.

Cover in the Industry Division commences and theInsured Member's Cover in the Personal Division willcease from the later of the following dates:

the date the Eligible Person commences workfor their most recent Employer on or after thePolicy Commencement Date; andthe start date of the period relating to the firstEmployer Contribution paid to the EligiblePerson's Account;

The Insured Member's Insured Amount of Cover inthe Industry Division will be equal to the greater of:

the amount that the Insured Member held in thePersonal Division immediately before transferringto the Industry Division; andthe Default Cover Amount

Insurance DefinitionsCapitalised words and expressions used throughoutthis Booklet have special definitions. The definitionsare as stated in our Insurance Policies. We have setout many of the key definitions from the InsurancePolicies below. Please refer to the Insurance Policiesfor the definitions of any terms which have specialmeanings that are not set out below.

At Work

means you are an Eligible Person & Gainfully Working;and

a are:

in the Insurer’s opinion, actively performing allthe duties of your occupation, free from anylimitation due to illness or injury and not onleave; oron Employer Approved Leave, or self-employedand on leave, taken for reasons unrelated toinjury or illness, and in the Insurer’s opinion,capable of actively performing all the duties ofyour occupation (being the occupation performed

by you when you last worked), free from anylimitation due to illness or injury, and

b are capable of performing all the duties ofyour occupation on a Full-time basis (even ifnot working Full-time); and

c are not in receipt of, or entitled to claim,income support benefits from any sourceincluding but not limited to workers’compensation benefits, statutory motoraccident benefits or disability income benefits(including government income supportbenefits of any kind).

An Eligible Person who does not meet theserequirements is correspondingly described as Not AtWork.

Australian Resident

means an Australian citizen, a New Zealand citizenor an ‘Australian permanent resident’ within themeaning of the Migration Act 1958 (Cth) and MigrationRegulations 1994 (Cth).

Claiming Member

means a person who:

a had a claim admitted;b is eligible to receive a benefit;c is in a waiting period for a benefit; ord is in the process of claiming a benefit;

for terminal illness, total and permanent disablement,total disability or partial disability.

Date of Disablement

means the later of:

a the date that a Medical Practitioner certifies,as the date that you have no capacity toperform one or more duties of your UsualOccupation necessary to produce income,which cannot be before the date of MedicalConsultation by that Medical Practitioner; and

b the date you cease working in your UsualOccupation.

Defence Force Reserve

means the Australian army, naval or air forcereserves.

25

Deliberate Self-Inflicted Act

means a deliberate self-inflicted act of the insuredmember, including but not limited to attemptedsuicide or suicide, whether or not the person is saneat the time.

Eligible Person

a is a Member; andb is either

i. an Australian Resident residing in oroutside Australia; or

ii. a holder of a Visa residing inAustralia; and

c is aged at least 15 years and not older thanthe Maximum Benefit Entry Age

on the date their Cover is due to commence orrecommence.

Employment

means Gainful Employment with an Employer

Full-time

means a person is working at least 35 hours perweek.

Gainfully Working

means a person:

is an Employee engaged in Gainful Employment;or is engaged in self-employment in an occupationor work for reward or financial benefit, or thehope of reward or financial benefit, whetherFull-time or Part-time.

Limited Cover

means an insured member will only be covered forTotal Disability and Partial Disability which does notarise either directly or indirectly, wholly or partially,from a Pre- Existing Condition of the insured member.

Long Term Cover

means the Cover based on a Benefit Period of ‘to age65’.

Medical Consultation

means any activity undertaken for the detection,treatment or management of an illness, injury,medical condition or related symptom, including butnot limited to the application of prescribed drugs ortherapy (whether conventional or alternative).

On Claim

means the dates for which you are eligible to receivea Disability Benefit with respect to an Insured Memberunder this Policy.

Partial Disability/Partially Disabled

means solely as a result of injury or illness, theInsured Member is:

a unable to perform one or more of the dutiesnecessary to produce income from their UsualOccupation,

b is working in their Usual Occupation oranother occupation, and has monthly Salaryless than their Pre-Disability Salary; and

c Following The Advice Of A Medical Practitionerin relation to their illness or injury for whichthey are claiming.

Pre-Disability Salary

means:

the total monthly value of Salary received by theinsured member from his or her Usual Occupationaveraged over the 12 month period preceding theDate of Disablement, or the actual period of time theinsured member worked if less than 12 months(provided the period of work occurred in the 12 monthperiod preceding the Date of Disablement and subjectto a minimum averaging period of 6 months),calculated by the Insurer based on the satisfactoryevidence available to the Insurer at the relevant time.

Pre-Existing Condition

means an injury, illness, condition or relatedsymptom, whether it was diagnosed by a MedicalPractitioner or not, which in the Insurer’s opinion:

a the Insured Member (or a reasonable personin their position) was aware of, or should havebeen aware of;

b the Insured Member had, or was intending tohave, a Medical Consultation; or

c a reasonable person in the circumstances ofthe Insured Member would have had aMedical Consultation,

as at or prior to the date cover commenced,recommenced or increased (with respect to theincreased Insured Amount of Cover only).

Short Term Cover

means Cover based on a Benefit Period of 24months.

26


Salary

means:

If the Insured Member is employed on a casualbasis, is a Contractor or earns income from abusiness they directly own part wholly or partly,Salary means the annual remuneration earnedby the Insured Member from all UsualOccupations.Where an Insured Member directly owns all orpart of the business in which they perform aUsual Occupation, their Salary is the totalamount earned by that business for the relevantperiod as a direct result of the Insured Member’spersonal exertion, less his or her share ofbusiness expenses, but before the deduction ofincome tax, for that business for the sameperiod.

Where the Insured Member does not fall withinparagraph 1 above, Salary for an Insured Membermeans the annual remuneration earned from workingfor their Employer and may include:

any packaged elements not received directly bythe Insured Member as taxable earnings; overtime and allowances; andperformance related commission (averaged overthe previous three years or since the InsuredMember commenced employment with theirEmployer if less); andperformance related bonuses (averaged overthe previous three years or since the InsuredMember commenced employment with theirEmployer if less).

but excludes any director’s fees, compulsory employersuperannuation entitlements, investment income andprofit distribution.

Totally Disabled/Total Disability

means solely as a result of injury or illness, theinsured member:

a ceases to be Gainfully Working including aperson who has ceased temporarily to receiveany gain or reward under a continuingarrangement for the person to be GainfullyWorking;

b is medically certified as being incapable ofperforming one or more duties of his or herUsual Occupation necessary to produceSalary;

c is not engaged in any occupation (whether ornot for reward), and

d is Following The Advice Of A MedicalPractitioner in relation to injury or illness forwhich they are claiming.

For the avoidance of doubt, an insured member cansatisfy (a) above despite the fact that he or she is onEmployer Approved Leave or Employer ApprovedUnpaid Leave as at the Date of Disablement.

Usual Occupation

means the occupation(s) in which the Insured Memberis regularly engaged at the time they suffer an injuryor illness which leads to their Total Disability or PartialDisability. For periods of Total Disability or PartialDisability which occur while the Insured Member who:

is an employee and was on Employer ApprovedLeave;

OR

is self-employed and was on leave,

it means the last occupation(s) the Insured Memberperformed immediately before the leave commenced.

Visa

means a current and valid visa permitting residency(excluding a visa which allows permanent residencyin Australia) or employment in Australia and issuedin accordance with the Migration Act 1958 (Cth) orany amending or replacing act, including but notlimited to sub class 457 working visa or sub class457 working visa (with an 8107 condition).

Waiting Period

for income protection cover, is the number ofconsecutive days for which you must be Disabledbefore a Disability Benefit begins to accrue.

27

War

includes, but is not limited to declared war, and armedaggression by one or more countries resisted by anycountry, combination of countries or internationalorganisations.

War Service

includes, but is not limited to participation in an actionto defend a country or region from civil disturbanceor insurrection, or in an effort to maintain peace.

Other defined terms

Refer to the relevant insurance policy for theremaining defined terms.

28


DisclosureInsurance admin fee

A portion of your premium is retained within the fundas an insurance administration fee to cover the costsof administering insurance. Refer to the premiumtables within this booklet for further information.

Your duty of disclosure

Club Plus Super (the Trustee) who enters into a lifeinsurance contract in respect of your life has a duty,before entering into the contract, to tell OnePath LifeLimited (the Insurer) anything that the Trustee knows,or could reasonably be expected to know, may affectthe Insurer’s decision to provide the insurance andon what terms.

The Trustee has this duty until the Insurer agrees toprovide the insurance.

The Trustee has the same duty before it extends,varies or reinstates the contract.

The Trustee does not need to tell the Insurer anythingthat:

reduces the risk the Insurer insures you for; oris of common knowledge; orthe Insurer knows or should know as an insurer,orthe Insurer waives your duty to tell the Insurerabout.

In order for the Trustee to comply with the duty ofdisclosure, we require you to tell us (the Trustee andthe Insurer), anything you know, or could reasonablybe expected to know, that may affect the Insurer’sdecision to insure you and on what terms.

If you do not tell the Trustee and Insurer somethingthat you know, or could reasonably be expected toknow, may affect the Insurer’s decision to providethe insurance and on what terms, this may be treatedas a failure by the Trustee entering into the contractto tell the Insurer something that we must tell theInsurer.

If you do not tell the Insurer and the Trusteesomething

In exercising the following rights, the Insurer mayconsider whether different types of cover canconstitute separate contracts of life insurance. If theydo, the Insurer may apply the following rightsseparately to each type of cover.

If you do not tell the Insurer and the Trustee anythingyou are required to, and the Insurer would not haveprovided the insurance or entered into the samecontract with the Trustee if you had told the Insurerand the Trustee, the Insurer may avoid the contractwithin 3 years of entering into it.

If the Insurer chooses not to avoid the contract, theInsurer may, at any time, reduce the amount ofinsurance provided. This would be worked out usinga formula that takes into account the premium thatwould have been payable if you had told the Insurerand the Trustee everything you should have. However,if the contract provides cover on death, the Insurermay only exercise this right within 3 years of enteringinto the contract.

If the Insurer chooses not to avoid the contract orreduce the amount of insurance provided, the Insurermay, at any time vary the contract in a way that placesthe Insurer in the same position it would have beenin if you had told the Insurer and the Trusteeeverything you should have. However this right doesnot apply if the contract provides cover on death.

If the failure to tell the Insurer is fraudulent, theInsurer may refuse to pay a claim and treat thecontract as if it never existed.

The Insurer's Privacy Statement

In this section ‘we’, ‘us’ and ‘our’ refers to OnePathLife Limited. ‘You’ and ‘your’ refers to policy ownersand life insureds. Any reference to your personalinformation includes any health or other sensitiveinformation we may hold about you.

We collect your personal information from you in orderto manage and administer our products and services.Without your personal information, we may not beable to process your application or provide you withthe products or services you require.

We are committed to ensuring the confidentiality andsecurity of your personal information. Our PrivacyPolicy details how we manage your personalinformation and is available on request or may bedownloaded fromonepath.com.au/insurance/privacy-policy

We may disclose your personal information to certainthird parties as outlined below.

Unless you consent to such disclosure we will not beable to consider the information you have provided.

29

3 Other insuranceinformation

Providing your information to others

The parties to whom we may routinely disclose yourpersonal information include:

an organisation that assists us to detect andprotect against consumer fraud;organisations performing administration and/orcompliance functions in relation to the productsand services we provide;organisations providing medical or other servicesfor the purpose of the assessment of anyinsurance claim you make with us (such asreinsurers);our solicitors or legal representatives;organisations maintaining our informationtechnology systems;organisations providing mailing and printingservices;persons who act on your behalf (such as youragent or financial adviser);the policy owner (or parties acting on behalf ofthe policy owner);regulatory bodies, government agencies, lawenforcement bodies and courts;our related companies (members of ZurichInsurance Group Ltd), including for carrying outany group business functions; organisations, including those in an alliance withus or our related companies, to distribute,manage and administer our products andservices, carry out business functions, enhancecustomer service and undertake analyticsactivities.

We will also disclose your personal information incircumstances where we are required by law to doso. Examples of such laws are:

The Family Law Act 1975 (Cth) enables certainpersons to request information about yourinterest in a superannuation fund;There are disclosure obligations to third partiesunder the Anti-Money Laundering and Counter-Terrorism Financing Act 2006.

Information required by law

We may be required by relevant laws to collect certaininformation from you. Details of these laws and whythey require us to collect this information arecontained in our Privacy Policy atonepath.com.au/insurance/privacy-policy

Privacy consent

Where you wish to authorise any other parties to acton your behalf, to receive information and/orundertake transactions please notify us in writing.

If you give us personal information about someoneelse, please show them a copy of this document orour Privacy Policy available atonepath.com.au/insurance/privacy-policy so that theymay understand the manner in which their personalinformation may be used or disclosed by us inconnection with your dealings with us.

Privacy Policy

Our Privacy Policy contains information about:

when we may collect information from a thirdparty;how you may access and seek correction of thepersonal information we hold about you; andhow you can raise concerns that we havebreached the Privacy Act or an applicable codeand how will deal with those matters.

You can contact us about your information or anyother privacy matter as follows:

GPO Box 75SydneyNSW 2001

In writing:

[email protected]:

We may charge you a reasonable fee for this.

If any of your personal information is incorrect or haschanged, please let us know by contacting CustomerServices on 133 667.

More information can be found in our Privacy Policyat onepath.com.au/insurance/privacy-policy

Overseas recipients

We may disclose your information to recipients(including service providers and related companies)which are (1) located outside Australia and/or (2) notestablished in or do not carry on business in Australia.

You can find details about the location of theserecipients in OnePath Life's Privacy Policy atonepath.com.au/insurance/privacy-policy

30

3 Other insuranceinformation

Club Plus Super Privacy PolicyYour right to privacy

Privacy Policy

Your personal information is collected so that we canadmit you as a member and provide you with theservices and benefits the fund offers.

Our Privacy Policy contains information about howyour personal information is collected, used, disclosedand held and how you can access and correct yourpersonal information and make a complaint about aprivacy breach. You should read the Privacy Policyat clubplussuper.com.au/privacy-policy beforeproviding your personal information. Call us on 1800680 627 for a hard copy of the Policy free of charge.

Why does Club Plus Super need my personalinformation?

The personal information Club Plus Super collectsabout you, is used to establish your super account,to process payments from your account, to correspondwith you and to provide you with superannuationbenefits and options from Club Plus Super.

The provision of some benefits and options to yourequires the provision by you of your personalinformation and, should you choose not to providenecessary information, it may not be possible toprovide those benefits and options to you.

There are other organisations that are connected tothe services we provide to you and which may haveaccess to your personal information. They include:

Mailing companies – organisations contractedto do all mailing for Club Plus Super;Archiving companies – organisations contractedto ensure that all documents are stored in asecure environment;Auditors, lawyers, the administrator andRegulators;Organisations that ensure Club Plus Super iscomplying with legislation and contractualobligations.

Contact Club Plus

If at any time you have any questions about Club PlusSuper or wish to change your personal detailsrecorded by Club Plus Super, you can contact us by:

1800 680 627Telephone:1300 663 844Fax: [email protected]:

Club Plus SuperLocked Bag 5007Parramatta NSW 2124

In writing:

1a Homebush Bay DriveRhodes NSW 2138clubplussuper.com.au

In person:

Privacy Officer

(02) 9376 9400Telephone:1300 855 374Fax: [email protected]: Privacy OfficerClub Plus SuperGPO Box 3774 Sydney NSW 2001

In writing:

If you are dissatisfied with the response of the PrivacyOfficer, you may lodge a complaint with the Office ofthe Australian Information Commissioner by [email protected] or by phoning 1300 363 992.

31

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CP/MBR/PS 496.5 09/19 ISS15

Page 1 of 24

Personal Statement

Insurance cover is provided by OnePath Life Limited ABN 33 009 657 176 AFSL 238 341 (the Insurer) and subject to the terms and conditions of the insurance policy issued to Club Plus Super by OnePath Life Limited (the Policy). You should read Club Plus Super’s PDS and Insurance Booklet applicable to your membership category (ie either Industry Division or Personal Division) for a summary of the terms and conditions of the Policy. You can download the applicable PDS and Insurance Booklet from clubplussuper.com.au/pds or contact Club Plus Super on 1800 680 627 if you would like a copy of the Policy.

Your application will be assessed by the Insurer and Club Plus Super will notify you of the outcome in writing.

The Insurer requires this form, and may require other health information, to determine your application for cover. This form is confi dential. Please refer to the OnePath Life’s Privacy Statement at Section F for more information about confi dentiality.

About the insurer

The Trustee who enters into a life insurance contract in respect of your life has a duty, before entering into the contract, to tell OnePath Life Limited (the Insurer) anything that they know, or could reasonably be expected to know, may affect the Insurer’s decision to provide the insurance and on what terms.

The Trustee has this duty until the Insurer agrees to provide the insurance.

The Trustee has the same duty before it extends, varies or reinstates the contract.

The Trustee does not need to tell the Insurer anything that:

• reduces the risk the Insurer insures you for; or

• is of common knowledge; or

• the Insurer knows or should know as an insurer, or

• the Insurer waives your duty to tell the Insurer about.

In order for the Trustee to comply with the duty of disclosure, we require you to tell us (the Trustee and the Insurer), anything you know, or could reasonably be expected to know, that may affect the Insurer’s decision to insure you and on what terms.

Duty of disclosure

Do you know you can apply for additional insurance online?It’s as easy as logging in to your account through MemberAccess at clubplussuper.com.au and going to the ‘Insurance Details’ tab, where you’ll fi nd the online forms to complete.

•

Return your signed and completed form to: Club Plus Super, Locked Bag 5007, Parramatta NSW 2124.

When to use this form

Please complete this form if you wish to:

• apply for, or increase your Death only, Death and Total and Permanent Disablement (TPD) or Income Protection (IP) cover with Club Plus Super;

• reduce the waiting period that applies to your Short Term Income Protection cover with Club Plus Super; and/or

• apply for Long Term Income Protection cover (in addition to any Short Term Income Protection cover) with Club Plus Super.

If you are an Industry division member and wish to apply for, or increase your Death only or Death and Total and Permanent Disablement (TPD) up to a maximum of $500,000 (including any existing cover), you may be eligible to apply for your cover using the Short Personal Statement instead of this form. The Short Personal Statement is available at clubplussuper.com.au/tools-forms

To ensure your Death Benefi t is paid to the people you want and as soon as possible after your death, you should advise the Trustee of your wishes. You can make your wishes clear by completing a Binding Death Benefi t Nomination form available at clubplussuper.com.au/tools-forms.

Binding Death Nomination

Page 2 of 24

If you do not tell the Trustee and Insurer something that you know, or could reasonably be expected to know, may affect the Insurer’s decision to provide the insurance and on what terms, this may be treated as a failure by the Trustee entering into the contract to tell the Insurer something that we must tell the Insurer.

If you do not tell the Insurer something

In exercising the following rights, the Insurer may consider whether different types of cover can constitute separate contracts of life insurance. If they do, the Insurer may apply the following rights separately to each type of cover.

If you do not tell the Insurer and the Trustee anything you are required to, and the Insurer would not have provided the insurance or entered into the same contract with the Trustee if you had told the Insurer and the Trustee, the Insurer may avoid the contract within 3 years of entering into it.

If the Insurer chooses not to avoid the contract, the Insurer may, at any time, reduce the amount of insurance provided. This would be worked out using a formula that takes into account the premium that would have been payable if you had told the Insurer and the Trustee everything you should have. However, if the contract provides cover on death, the Insurer may only exercise this right within 3 years of entering into the contract.

If the Insurer chooses not to avoid the contract or reduce the amount of insurance provided, the Insurer may, at any time vary the contract in a way that places the Insurer in the same position it would have been in if you had told the Insurer and the Trustee everything you should have. However this right does not apply if the contract provides cover on death.

If the failure to tell the Insurer is fraudulent, the Insurer may refuse to pay a claim and treat the contract as if it never existed.

Duty of disclosure (cont.)

May one of our underwriting staff or OnePath authorised service providers contact you by phone if we require more information?

Yes No

If yes, when is the most convenient day(s) and time and on which phone number?

Days: Time:

From to

Phone:

H W M

Section A: Your details

Surname: Given name(s):

Address: (this cannot be a PO Box)

Email: Date of birth (DD/MM/YY):

Suburb PostcodeState

Home number: Work number: Mobile number:

( ) ( ) ( )

Title: Mr/Mrs/Ms/Miss/Other Member number:

Male Female

Page 3 of 24

Personal Statement (cont.)

Section B: Details of insurance cover you are applying for

Select the insurance you wish to apply for by inserting a in the relevant box.

Death and TPD coverI wish to apply for / increase my cover to the following:

Unitised cover

Please refer to the PDS applicable to your membership division for the insurance amount of one unit of cover for all ages.

Death number of units and

TPD* number of units or

Death only number of units

Fixed cover**

Death $ ,000 and

TPD* $ ,000 or

Death only $ ,000

*The amount of TPD cover cannot exceed the amount of Death cover. You cannot hold TPD only cover.

**Fixed cover must be in multiples of $1,000.

Income protection coverTo be eligible to hold income protection cover, you must currently be working. In addition, if you are an Industry division member, your employer must be paying SG contributions to your account for you to hold Short Term Income Protection cover.

Short Term Income Protection cover

a) I wish to apply for/increase my cover to the following:

Short Term Income Protection $ per month (this should be 90% of your current income)

b) Please select one from the following waiting period options*:

21 days (default) 45 days 90 days

*If you are applying to reduce your waiting period, increased premiums may apply.

Long Term Income Protection cover

a) I wish to apply for/increase my cover to the following:

Long Term Income Protection $ per month (this should be 75% of your current income)

Page 4 of 24


1. RESIDENCE AND TRAVEL DETAILS

1. Are you currently residing in Australia?

If no, please advise where you are currently residing and how long you intend to reside there? Yes

No

2. Are you an Australian citizen or do you hold a visa that entitles you to reside permanently in Australia? If yes, please proceed to question 3. If no, please advise what type of visa you hold.

Yes

No

3. Do you have any intention of travelling outside Australia within the next two years? If yes, please complete the following:

Yes No

Date of departure (dd/mm/yy): Duration of stay: Destination(s) (country/cities):

Purpose of stay: Holiday Business Residing Other Please specify if other

2. INSURANCE DETAILS

1. Are you covered by, or are you applying for, any other life, TPD, trauma, income protection, salary continuance or living expense cover with any company, including OnePath Life (other than this application), including benefi ts under superannuation or insurance benefi ts by your employer? Yes No

If you have answered yes, please indicate which insurance(s) and provide details of the date the policy was last fully underwritten in the table below:

Name of company Type of cover Amount insured

Date commenced(dd/mm/yy)

Will this policy be discontinued/replaced?

Date last fully underwritten (replacement policies only) (dd/mm/yy)

$ / / Yes

No / /

$ / / Yes

No / /

2. Have you ever had an application for insurance on your life declined, deferred, accepted with a higher than normal premium or issued with restrictions or exclusions?

If yes, please provide name of company, alteration, date and reason (if known).

Yes No

3. Have you ever made a claim for or received sickness, accident or disability benefits, Veterans Affairs benefits, Workers’ Compensation, unemployment benefits or any other form of compensation?

If yes, please provide details i.e. when, amount, period paid, type of disability suffered, date claim finalised etc.

Yes No

Section C: Questionnaire

Page 5 of 24


3. OCCUPATION DETAILS

1. What is your usual occupation?

2. Describe all present duties in the table below (please complete both percentage of time and specifi c duties in all cases)

Type of work % of time Please describe your specific duties and where they are performed

Sedentary/administration (e.g. filing, computer work, answering telephone, reception duties, etc.)

Manual work – light (e.g. driving, warehousing, surveying, lifting under 5kgs, etc.)

Manual work – heavy (e.g. bricklaying, lifting over 5kgs, painting, carpentry, mechanic, etc.)

3. How many hours (on average) do you work per week?

4. What is your current annual income earned through personal exertion, before tax, and including superannuation contributions, but after deduction of business expenses? $ ,

5. Do you have more than one occupation? Yes No

If yes, please specify the occupation, your normal duties and the average hours you work per week in each of your other occupation(s):

4. PASTIMES

Do you engage in any hazardous pastimes or pursuits such as, but not limited to, football (other than touch or Oztag), motorised sports, parachuting, hang-gliding, abseiling, mountaineering activities, aviation (other than a fare paying passenger), scuba diving or any sport(s) in a professional capacity?

Yes No

If you answered yes to the above, provide details of the activity and the frequency with which you participate in this activity, including maximum speed/height/depth:

How often do you participate in this activity? times per year

Section C: Questionnaire (cont.)

Page 6 of 24


5. PERSONAL STATEMENT

1. What is your current height and weight? Height (cm) Weight (kg)

2. Has your weight varied by more than 10kg during the last 12 months (excluding pregnancy)?

If yes, please provide details. Yes No

3. During the last 12 months have you smoked tobacco or any other substance?

If yes, please state type and quantity per day. Yes No

4. During the last three months, have you used nicotine replacement therapy (e.g. nicotine gum, patches, etc.)or anti-smoking medication (e.g. Zyban, Chantix, etc.)?

If yes, please state type(s) used and length of time you have been using this. Yes No

5. Non-smokers – have you ever smoked regularly in the past?If yes, please state type, quantity per day and date ceased. Yes No

6. Do you consume alcohol?If yes, please state how many standard drinks you consume per day (a standard drink is 125ml wine, 250ml beer or 30ml spirits).

Yes No

7. Have you ever been advised to stop or reduce your alcohol intake due to a medical condition?If yes, please provide full details. Yes No

6. FAMILY HISTORY

To be completed for your blood relatives only (if adopted and family history unknown, please state so).

1. Have any of your parents, brothers or sisters (alive or deceased) suffered from Huntington’s disease, muscular dystrophy, diabetes mellitus, breast cancer, bowel cancer, ovarian cancer, multiple sclerosis, motor neurone disease, familial adenomatous polyposis of the bowel, polycystic kidney disease, Alzheimer’s disease, dementia or any other hereditary or familial disorder?

Yes No

2. Have any of your parents, brothers or sisters (alive or deceased) been diagnosed before the age of 60 with any of the following conditions: heart disease, stroke, mental illness, haemochromatosis, cervical cancer, prostate cancer, melanoma or any other cancer (please specify type)?

Yes No

If you answered yes to either question 1 or 2, please complete the following table.

Relation Condition/Disorder Age diagnosed

Note: You are only required to disclose family history information pertaining to first degree blood related family members – living or deceased (mother, father, brothers, sisters).


Page 7 of 24


7. MEDICAL HISTORY

To the best of your knowledge, have you ever had any of the following:Please tick the appropriate box and circle the specific conditions that are applicable.

1. Asthma? Yes No

2. High blood pressure? Yes No

3. High cholesterol? Yes No

4. Diabetes? Yes No

5. Stress, anxiety, depression or any other mental health condition? Yes No

6. Back or neck pain, sciatica or any disorder of the spine or neck? Yes No

7. Arthritis, shoulder or knee pain or any other disorder of the joints? Yes No

8. Cyst, mole or skin lesion? Yes No

If you answered yes to any of the conditions in bold above, please complete the relevant questionnaire on pages 15 to 23.

9. Sleep apnoea, bronchitis, persistent cough or any other chest or lung condition? Yes No

10. Heart condition, murmur, chest pain, rheumatic fever, palpitations, stroke or vascular disorder? Yes No

11. Thyroid or glandular trouble? Yes No

12. Ulcers, bowel trouble or recurring indigestion? Yes No

13. Epilepsy, fi ts or dizziness, fainting of any kind or persistent headaches? Yes No

14. Alzheimer’s disease or dementia? Yes No

15 Kidney, liver, prostate or bladder problems, renal colic or stones, nephritis, lupus nephritis, pyelitis or cystitis? Yes No

16. Broken bones or osteoporosis or any pain, strain or disorder of any muscles, ligaments, cartilage or limbs? Yes No

17. Gout, fibromyalgia, tendonitis, tenosynovitis, RSI, or any regional pain syndrome, chronic fatigue syndrome (myalgic encephalomyelitis)? Yes No

18. Cancer, tumour, growths of any kind or breast lumps (even if you have not seen a doctor)? Yes No

19. Varicose veins, hernia, scleroderma, systemic sclerosis or skin disorders? Yes No

20. Any abnormality affecting eyesight, hearing or speech? Yes No

21. Any abnormality affecting physical mobility or muscular power (e.g. multiple sclerosis or any diagnosed intellectual disability or cognitive impairment?) Yes No

22. Anaemia, haemophilia or any other disease of the blood? Yes No

23. Bowel, liver or gall bladder disease or hepatitis? Yes No

24. Coughing of blood or passing of blood from the bowel or in the urine? Yes No


Page 8 of 24


7. MEDICAL HISTORY (CONT.)

25. Have you within the last five years had any other illness, injury, operation, X-ray, electrocardiogram, blood transfusion, any other special tests or been advised to have a blood test for any reason? Yes No

26. Due to injury or illness have you ever been off work for more than seven consecutive days (if not already mentioned)? Yes No

27. Do you now have any symptoms of ill health or disability? Yes No

28. Are you contemplating surgery, intending to consult a doctor, or have you been advised to have an operation or other medical investigation or test in the future? (e.g. x-ray, ECG, blood test, etc) Yes No

29. Do you take, or have you ever taken drugs or any medications on a regular or ongoing basis? Yes No

30. Have you ever used or injected any drugs not prescribed for you by a medical attendant or have you ever received advice, counselling or treatment for drug dependence? Yes No

31.A Is the combined total of your existing insurance(s) detailed in section 2 Question 1, and any new insurance you are applying for with OnePath Life, more than any one of the following; $500,000 Death; $500,000 TPD; $200,000 Trauma; $4,000 per month in total of any combination of Income Protection/Business expense/Living expense/salary continuance cover?

Yes No

If you answered Yes to question 31(A) please proceed to 31(B), otherwise continue to question 32

31.B Have you ever had, or have you scheduled an appointment to have a genetic test where you received (or are currently awaiting) an individual result? (please do not include any test conducted solely for the purpose of medical research study where the result of the test has not been or will not be, provided to you).

Yes No

32. Females only

a. Have you ever had any complications with pregnancy or childbirth? Yes No

b. Are you now pregnant? If yes, please advise due date (dd/mm/yy) Yes No

c. Have you ever had an abnormal cervical smear test (pap), breast ultrasound or mammogram? Yes No

d. Have you ever had any symptom(s) of, or sought advice or treatment for any condition of the cervix, ovary, uterus, breast, or endometrium? Yes No

33. Are you suffering from unintentional weight loss, persistent night sweats, persistent fever, diarrhoea or swollen glands? Yes No

34. Have you ever tested positive for HIV (Human Immunodeficiency Virus), which causes AIDS (Acquired Immune Deficiency Syndrome), or are you suffering from AIDS or any AIDS related condition?

Yes No

35. Have you received or are you expected to receive treatment, or undergo a medical consultation for a sexually transmitted disease including but not limited to HIV (AIDS), gonorrhoea or syphilis? Yes No


Page 9 of 24


7. MEDICAL HISTORY (CONT.)

If you answered yes to any questions from 9–35, please complete the following table. If there is not enough space here, please provide details on page 24.

If you answered no to all questions from 9–35, please complete Part 8 of Section C and Sections D and E on pages 11 to 13.

Question number

Disability, illness, injury or condition

Investigation type(s) and result(s)

Date of first symptoms (dd/mm/yy)

Frequency of symptoms

Type of treatment

Date treatment provided and ceased (dd/mm/yy): From to

Has further treatment, referral or investigation(s) been recommended? Yes No

Time off work

Have you completely recovered? Yes No Date of last symptoms (dd/mm/yy)

Name and address of medical facility and attending doctor

Question number





Type of treatment



Time off work




Page 10 of 24


Question number





Type of treatment



Time off work



Question number





Type of treatment



Time off work




Page 11 of 24


8. USUAL DOCTOR OR MEDICAL CENTRE DETAILS

1. Full name and address of usual doctor/medical centre.

2. How many years have you been attending this doctor/medical centre? Years Months

a. When was your last visit to this doctor/medical centre?

b. Reason for check up or consultation?

c. Outcome including medication, treatment etc.

d. Degree of recovery?

%

3. Have you had any consultations with your usual doctor or any other doctor (other than for colds or the flu) in the last three years not already mentioned?

If yes, please provide details.Name, address and phone number of doctor/medical centre

Date lastconsulted (dd/mm/yy)

Reason for check-up or consultation

Outcome including degree of recovery, medication, treatment, etc.

/ /

/ /

/ /

/ /


Doctor/Medical centre:

Phone: Fax:

Address:

Suburb/Town PostcodeState

Yes No

DOCTOR’S AUTHORISATION

To be completed and signed by the life insured.

I hereby authorise you to release details of my personal medical history to OnePath Life Limited ABN 33 009 657 176 AFSL 238341, or any organisation duly appointed by OnePath Life. A photocopy (or similar) of this authorisation shall be as valid as the original.

Section D: Authorisations

Name of life insured:

Address of life insured:

Suburb/Town

To doctor:

Date of birth (dd/mm/yyyy):

Please sign authorisation

Postcode

Policy number:

State

Signature of life insured:Date (dd/mm/yyyy):

✗

Page 12 of 24


DOCTOR’S AUTHORISATION

To be completed and signed by the life insured.

I hereby authorise you to release details of my personal medical history to OnePath Life Limited ABN 33 009 657 176 AFSL 238341, or any organisation duly appointed by OnePath Life. A photocopy (or similar) of this authorisation shall be as valid as the original.

Section D: Authorisations (cont.)

Name of life insured:

Address of life insured:

Suburb/Town

To doctor:

Date of birth (dd/mm/yyyy):

Please sign authorisation

Postcode

Policy number:

State

Signature of life insured:Date (dd/mm/yyyy):

✗

Page 13 of 24


Section E: Declaration

• I have obtained, read and understood the insurance information in the current Club Plus Super PDS and Insurance Booklet applicable to my membership category (ie either Industry Division or Personal Division).

• I have read and understood the questions in this Personal Statement.• The answers I have provided to the questions in this Personal Statement (including all questions in this form that appear

after this Declaration) signed by me are true and correct.• I have read the Privacy Statement at Section G of this form (The Insurer’s Privacy Policy details how the Insurer manages

personal information. It is available free of charge by calling 133 667 or may be downloaded from onepath.com.au/insurance/privacy-policy.)

• I consent to the collection, use, storage and disclosure of my personal information (including health and other sensitive information) as described in the Privacy Statements on this form (see Sections F and G).

• I understand my duty of disclosure and the remedies available to the Insurer if I fail to comply with my duty of disclosure under the Insurance Contracts Act 1984. I understand that my duty of disclosure continues after I have completed this application until I am notified in writing that my application for insurance has been accepted.

• I authorise any medical practitioner, other professional or any person named in this Personal Statement to verify any aspect of it, and disclose any information that they may possess about me to the Insurer in relation to insurance issued under the Policy.

• I understand that the Insurer may require additional information or medical tests to enable assessment of my application. I understand that if I fail to attend any required medical appointments, my application may not be accepted by the Insurer.

• I understand that if my application is accepted by the Insurer: • the cover I have applied for will replace any cover I may already hold within Club Plus Super; • the cover I have applied for will not commence until my application is accepted by the Insurer in writing; • any existing cover will not be affected should my application be declined by the Insurer; and • insurance cover will be provided to me on the terms contained in the Policy as changed from time to time. • I acknowledge that if I do not complete this form correctly or I do not sign and date this Declaration, my application will not be

considered by the Insurer.

✗

Member’s signature

Date (DD/MM/YY)

Section F: Privacy Statement - Club Plus Super

The personal information provided on this form is collected by and held for Club Plus Super by the fund administrator AustralianAdministration Services (AAS) in accordance with the Australian Privacy Principles of the Privacy Act 1988 (Cth), for the purpose ofadministering accounts and providing services associated with your membership of the Fund.

You should read the Privacy Policy at clubplussuper.com.au/privacy-policy before completing the form. Call us on 1800 680 627 for a hard copy of the Policy. The Policy contains information about how personal information is collected, used and disclosed, how you can correct your personal information, make a complaint about a privacy breach and other important information about safeguards in place to protect your personal information.

By providing your information, you acknowledge that you have read and understood the Privacy Policy.

Page 14 of 24


In this section ‘we’, ‘us’ and ‘our’ refers to OnePath Life Limited. ‘You’ and ‘your’ refers to policy owners and life insureds.

Any reference to your personal information includes any healthor other sensitive information we may hold about you.We collect your personal information from you in order tomanage and administer our products and services. Withoutyour personal information, we may not be able to processyour application or provide you with the products or servicesyou require.

We are committed to ensuring the confidentiality andsecurity of your personal information. Our Privacy Policydetails how we manage your personal information andis available on request or may be downloaded fromonepath.com.au/insurance/privacy-policy.

We may disclose your personal information to certain thirdparties as outlined below. Unless you consent to such disclosure we will not be able to consider the information you have provided.


The parties to whom we may routinely disclose your personalinformation include:• an organisation that assists us to detect and protect against

consumer fraud• organisations performing administration and/or compliance

functions in relation to the products and services we provide• organisations providing medical or other services for the

purpose of the assessment of any insurance claim you make with us (such as reinsurers)

• our solicitors or legal representatives• organisations maintaining our information technology systems• organisations providing mailing and printing services• persons who act on your behalf (such as your agent or

financial adviser)• the policy owner (or parties acting on behalf of the policy

owner)• regulatory bodies, government agencies, law enforcement

bodies and courts• our related companies (members of Zurich Insurance Group

Ltd group), including for carrying out any group business functions

• organisations, including those in an alliance with us or our related companies, to distribute, manage and administer our products and services, carry our business functions, enhance customer service and undertake analytics activities.

We will also disclose your personal information in circumstances where we are required by law to do so.

Examples of such laws are:

• the Family Law Act 1975 (Cth) enables certain persons to request information about your interest in a superannuation fund;

• there are disclosure obligations to third parties under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006.


We may be required by relevant laws to collect certaininformation from you. Details of these laws and why they requireus to collect this information are contained in our Privacy Policyat onepath.com.au/insurance/privacy-policy

Privacy consent

Where you wish to authorise any other parties to act on yourbehalf, to receive information and/or undertake transactions,please notify us in writing.

If you give us personal information about someone else, youmust show them a copy of this document or our Privacy Policyavailable at onepath.com.au/insurance/privacy-policy so that they may understand the manner in which their personal information may be used or disclosed by us in connection with your dealings with us.

Privacy Policy

Our Privacy Policy contains information about:• when we may collect information from a third party • how you may access and seek correction of the personal

information we hold about you and• how you can raise concerns that we have breached the

Privacy Act or an applicable code and how we will deal with those matters.

You can contact us about your information or any other privacymatter as follows:

In writing: GPO Box 75 Sydney NSW 2001Email: [email protected]

We may charge you a reasonable fee for this.If any of your personal information is incorrect or has changed,please let us know by contacting Customer Services on 13 36 67.


Overseas recipients

We may disclose your personal information to recipients(including service providers and related companies) which are(1) located outside Australia and/or (2) not established in or do not carry on business in Australia.

You can find details about the location of these recipients inOnePath Life’s Privacy Policy at onepath.com.au/insurance/privacy-policy

Section G: Privacy Statement - OnePath Life Limited

Page 15 of 24


ASTHMA QUESTIONNAIRE

Only complete this questionnaire if you answered yes to question 1 in Section 7.

1. When did you have your first episode of asthma? Date (dd/mm/yy)

2. When was your most recent episode of asthma? Date (dd/mm/yy)

3. Approximately how many episodes have occurred in the last 12 months?

4. Have you had any time off work due to this condition?If yes, please provide the dates and duration.

Yes No

5. Are the symptoms/attacks typically precipitated by anything in particular (e.g. seasonal, exercise induced, a cold or bronchitis)?

If yes, please provide details.

Yes

No

6. Have you sought medical treatment or advice for asthma?If yes, please provide details.

7. How has your doctor described your asthma? Mild Moderate Severe

Yes

No

8. Have you ever used any medication, including steroids? Yes

No


Type Date commenced(dd/mm/yy)

Frequency (e.g. daily, weekly)

Dosage Date ceased(if applicable)(dd/mm/yy)

Reason for cessation

/ / / /

/ / / /

9. Have you ever been hospitalised due to asthma?If yes, please provide details.

Date from (dd/mm/yy) Date to (dd/mm/yy)

Name and address of hospital.

Yes

No

10. Have you ever had lung function tests performed?If yes, please provide details.

Yes No

Date (dd/mm/yy) Test results

/ /

/ /

Section H: Supplementary questionnaires

Name of doctor/health professional:

Address:


Date of last consultation: (dd/mm/yy)

This page and the following pages are only required to be completed if you answered yes to any of questions 1 to 8 in section 7 of Section C (see page 7). If you answered No to all of these questions, your application is complete.

Page 16 of 24


Section H: Supplementary questionnaires (cont.)

BLOOD PRESSURE QUESTIONNAIRE


1. When was your high blood pressure first diagnosed?

Date (dd/mm/yy)

2. What was your blood pressure reading at that time? Systolic Diastolic

3. Have you ever been treated by medication? Yes

No



Frequency(e.g. daily, weekly)



/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

4. Did you undergo any tests or investigations?

Yes No


Tests performed Date commenced(dd/mm/yy)

Results

/ /

/ /

5. Is the treating doctor different to your usual doctor?

Yes No


Name:

Address:


Date of last consultation (dd/mm/yy):

6. What was the date of your last blood pressure check? (dd/mm/yy)

7. What was your blood pressure reading at that time?

Systolic Diastolic

8. How has your doctor described your blood pressure control? Excellent Good Poor Other If other, please provide details.

9. When was your high blood pressure first diagnosed? Date (dd/mm/yy)

Page 17 of 24


CHOLESTEROL QUESTIONNAIRE


1. When was your high cholesterol first diagnosed?

Date (dd/mm/yy)

2. What were your cholesterol readings at that time? Cholesterol Triglycerides

HDL Cholesterol LDL Cholesterol

3. Did you undergo any tests or investigations?

Yes No


Tests performed Date (dd/mm/yyyy) Results

/ /

/ /

4a. Have you ever used any medication?

If yes, please provide details. Yes

No


Frequency(e.g. daily, weekly)



/ / / /

/ / / /

/ / / /

4b. Has this treatment ever changed (e.g. has the type or dosage of your medication been changed)?If yes, please provide date of when treatment changed and the reason(s) for change.

Yes No

5. Is the treating doctor different to your usual doctor?If yes, please provide details.

Yes No

Name:

Address:



6. What was the date of your last cholesterol check?

Date (dd/mm/yy)

7. What were your cholesterol readings at that time? Cholesterol Triglycerides

HDL Cholesterol LDL Cholesterol

8. How has your doctor described your blood pressure control? If other, please provide details. Excellent Good Poor Other

9. What is the date of your next cholesterol check-up? Date (dd/mm/yy)


Page 18 of 24


DIABETES QUESTIONNAIRE


1. When was your diabetes first diagnosed?

Date (dd/mm/yy)

2. How is your diabetes controlled?

Insulin – go to question 3

Diet only – go to question 4

Oral – list medications below and then go to question 4

3. How many times a day do you administer insulin?

I’m on an insulin pump One or two times daily Three or more times daily

4. How often do you monitor your sugar levels? One or two times daily Three or more times daily Other

If other, please provide details.

5. Have you ever had insulin reactions, diabetic coma, heart, kidney, peripheral vascular disease or eye problems (not already mentioned in the Personal Statement), or protein in the urine?


Yes No

Condition Date (dd/mm/yy) Treatment

/ /

/ /

/ /

6. Have you had a glycosylated haemoglobin (HbA1c) test in the last six months?If yes, please provide details.

Yes

No

Date (dd/mm/yy) Test results

/ /

/ /

/ /


If yes, please provide details. Yes No

Name:

Address:




Page 19 of 24


MENTAL HEALTH QUESTIONNAIRE

Only complete this questionnaire if you answered yes to question 5 in section 7.

1. Please tick the conditions you have had (or currently have), or received treatment for:

Anxiety including generalised anxiety, panic or phobia disorder

Eating disorder including anorexia nervosa or bulimia

Depression including major depression or dysthymia

Manic depressive illness or bi-polar disorder

Alcohol or other substance abuse or addiction

Post traumatic stress

Schizophrenia or any other psychotic disorder

Stress, sleeplessness or chronic tiredness

Other

If other, please describe.

2. Please complete the table below for all described conditions.

Condition Describe your symptoms Date diagnosed(dd/mm/yy)

Date condition ceased (if applicable)(dd/mm/yy)

/ / / /

/ / / /

/ / / /

/ / / /

3. Have you ever had any recurrence of the symptoms?If yes, please provide details including dates.

Yes No

4. Are you currently symptom free?If yes, please provide date(s) of last symptoms.

Yes No

5. Have you ever attempted suicide or self harm?If yes, please provide details including when, name and address of treating doctor, clinic or hospital.

Yes No

6. Are you aware of the cause or reason for your condition(s)?If yes, please provide details.

Yes No


Page 20 of 24


MENTAL HEALTH QUESTIONNAIRE (CONT.)

7. Have you ever had any time off work due to your condition(s)?If yes, please provide the dates and duration.

Yes No

8. Are you currently or have you ever been on treatment, including medication?


No

Treatment (e.g. tranquillisers, sedatives, ECT, counselling, etc.)

Date commenced (dd/mm/yy)

Date ceased(if applicable) (dd/mm/yy)

Reason ceased

/ / / /

/ / / /

9. Do you feel that your condition(s) has had any impact on your ability to perform your job at work or on your social life?


Yes

No

10. Have you been referred for consultation with a psychiatrist or psychologist?


Yes No

Name of consultant:

Address:

Suburb/Town

PostcodeState


11. Have you been admitted to hospital or any other care facility?


Yes No

Name of consultant:

Address:

Doctor(s) consulted:

Suburb/Town

PostcodeState



Page 21 of 24


BACK/NECK QUESTIONNAIRE

Only complete this questionnaire if you answered yes to question 6 in section 7.

1. When did your back/neck condition first occur?

Date (dd/mm/yy)

2. Which area(s) of your back/neck was affected (e.g. middle back)?

3. What was the cause or reason for the condition?

4. Please describe the exact nature of the condition, including the symptoms and doctor’s diagnosis if known (e.g. sciatica, prolapsed disc, whiplash etc.):

5. Was an X-ray, CT scan or any other type of investigation performed?


No

Tests performed Date commenced (dd/mm/yy)

Results

/ /

/ /

6. Have you had recurrent or multiple episodes of the back/neck condition?

If yes, please provide details including the number of episodes and the date of the most recent episode including duration.

Yes

No

7. Please provide details of all people you have consulted for this condition in the table below.

Name and address of doctor/health professional

Type (e.g. doctor, chiropractor, physiotherapist)

Date last consulted(dd/mm/yy)

Treatment prescribed (e.g. analgesics, anti-inflammatory drugs, immobilisation)

/ /

/ /

8. Have you had any time off work due to this condition?

If yes, please provide the dates and duration. Yes

No

9. Are your work duties or activities limited/affected by the condition?


No

10. Are you still undergoing treatment or do you have any residual pain, limitation of movement or restriction of any kind?


Yes No

11. Overall do you feel that your back/neck condition is:

Resolved Improving

Stable

Deteriorating

12. What was the date of your last symptoms? Date (dd/mm/yy)


Page 22 of 24


ARTHRITIS/JOINT QUESTIONNAIRE


1. Which joint is/was affected (please tick relevant box/es)? If more than one box is ticked, please copy this questionnaire and complete for each condition.

Left Right Left Right

Ankle

Wrist

Elbow

Hip

Shoulder

Other

Knee

If other, state which joint

2. When did this condition first occur? Date (dd/mm/yy)

3. What was the cause or reason for the condition?

4. Please describe the exact nature of the condition, including symptoms and doctor’s diagnosis if known.

5. Have you had recurrent or multiple episodes of the condition?

If yes, please provide details including the number of episodes and the date of the most recent episode including duration.

Yes

No

6. Please provide details of all people you have consulted for this condition in the table below.

Name and address of doctor/health professional

Type (e.g. doctor, chiropractor, physiotherapist)

Date last consulted(dd/mm/yy)

Treatment prescribed (e.g. analgesics, anti-inflammatory drugs, immobilisation)

/ /

/ /

7. Have you had any time off work due to this condition?If yes, please provide the dates and duration.

Yes No

8. Do you have any residual pain, limitation of movement or restriction of any kind?If yes, please provide details.

Yes No

9. Are your work duties or activities limited/affected by the condition?If yes, please provide details.

Yes No

10. Are you still undergoing treatment?If yes, please provide details.

Yes No

11. Overall do you feel that your back/neck condition is:

Resolved Improving

Stable

Deteriorating

12. What was the date of your last symptoms? Date (dd/mm/yy)


Page 23 of 24


CYST/MOLE/SKIN LESION QUESTIONNAIRE


1. Please provide details in the table below.

Site (e.g. back, left leg)

Date diagnosed(dd/mm/yy)

Type (e.g. basal cell carcinoma, melanoma, cyst, mole)

Pathology results (e.g. malignant, benign, unknown)

/ /

/ /

/ /

2. Was the cyst/mole/skin lesion(s) removed?

Yes No

If yes, please provide details for each Date of removal (dd/mm/yy)

By what method (e.g. surgically, frozen or burnt off)?

If no, please provide details including date set for removal, if applicable.

3. Have you been or are you required to attend any further treatment or regular follow up since the

original removal?

If yes, please provide details and advise how often follow up is required.

Yes

No

4. Have you had any other tests, investigations or treatments not mentioned above?


No

Tests/Treatments/Investigations Date(dd/mm/yy)

Results

/ /

/ /

/ /


If yes, please provide details for each Yes

No

Name:

Address:

Suburb/Town

PostcodeState



Page 24 of 24


ADDITIONAL INFORMATION/COMMENTS


Section A: Your details

Surname: Given name(s):

Address:

Date of birth (DD/MM/YYYY):Email:

Title: Mr/Mrs/Ms/Miss/Other Member number:

Suburb PostcodeState

Home number: Work number: Mobile number:

( ) ( ) ( )

CP/ICR/FM 854.4 09/19 1SS6

Contact usmember hotline: 1800 680 627 email: [email protected] website: clubplussuper.com.au

Club Plus Superannuation Pty Ltd ABN 26 003 217 990, AFSL No. 245362 RSE Licence No. L0000529 as trustee of Club Plus Superannuation Scheme

ABN 95 275 115 088, RSE Registration No. R1000757

Do you know you can cancel your insurance cover over the phone?Just call our Member Hotline on 1800 680 627 to cancel (opt out of) any existing Death, TPD and/or Income Protection cover.

•

Return your signed and completed form to: Club Plus Super, Locked Bag 5007, Parramatta NSW 2124.

When to use this form

Please complete this form if you wish to make any of the following changes to your cover with Club Plus Super:

• Reduce or cancel your Death only, Death and Total and Permanent Disablement (TPD) or Income Protection (IP) cover;• Increase the waiting period that applies to your Short Term IP cover; and/or• Switch your Death only or Death and TPD cover between fi xed or unitised.

If you elect to cancel or reduce your cover and later wish to obtain or increase your cover, you will need to provide health evidence and be assessed by the insurer. We therefore recommend that you consider obtaining fi nancial advice before cancelling or reducing your insurance cover.

To ensure your Death Benefi t is paid to the people you want and as soon as possible after your death, you should advise the Trustee of your wishes. You can make your wishes clear by completing a Binding Death Benefi t Nomination form available at clubplussuper.com.au/tools-forms.

Binding Death Nomination

Insurance cover is provided by OnePath Life Limited ABN 33 009 657 176 AFSL 238 341 (the Insurer) and subject to the terms and conditions of the insurance policy issued to Club Plus Super by OnePath Life Limited (the Policy). You should read Club Plus Super’s PDS and Insurance Booklet applicable to your membership category (ie either Industry Division or Personal Division) for a summary of the terms and conditions of the Policy. You can download the applicable PDS and Insurance Booklet from clubplussuper.com.au/pds or contact Club Plus Super on 1800 680 627 if you would like a copy of the Policy.

Your application will be assessed by the Insurer and Club Plus Super will notify you of the outcome in writing.

This form is confi dential. Please refer to the OnePath Life’s Privacy Statement at Section G of this form for more information.

Before you complete this form, please ensure you read the “Your duty of disclosure” information on page 4.

About the insurer

Page 1 of 6

Insurance Variation, Cancellation or Reduction

May one of our underwriting staff or OnePath authorised service providers contact you by phone if we require more information?

If yes, when is the most convenient day(s) and time and on which phone number?

Days: Time:

From to

Yes No

Phone:

H W M

Section A: Your details (cont.)

Please select the insurance changes you wish to make by inserting a ✔ in the relevant box.

I wish to convert my unitised cover to fixed cover.

The dollar value of any units of Death and TPD cover you hold will be converted to an equivalent amount of fi xed dollar cover, rounded up to the next $1,000 (if not already a multiple of $1,000). Your sum insured will remain the same each year, but the premium may increase.

I wish to convert my fi xed cover to unitised cover.

Subject to you satisfactorily answering the statements below, any Death and TPD cover you hold will be converted to an equivalent amount of units of that cover, rounded up to the nearest whole unit.

As at the date of completing this application, I declare that:

• I am not off work due to injury or illness or restricted from performing any of the usual duties of my occupation due to injury or illness on a full-time basis of at least 35 hours per week (even if not currently working on a full-time basis).

True False

• I have not been paid, am not eligible to be paid, nor have I lodged a claim for any type of sickness, accident or disability (including total and permanent disability or terminal illness) benefi ts(s) from any source including but not limited to a life insurer or WorkCover authority, statutory motor accident authority and Centrelink.

True False

• I have not been diagnosed with any illness that reduces my life expectancy to less than 12 months from today. True False

If you answered FALSE to any of the above statements, you cannot convert your fi xed cover to unitised cover without providing additional health information. You can still apply to convert from fi xed cover to unitised cover by completing the Personal Statement available on our website at clubplussuper.com.au/tools-forms

I wish to increase the waiting period that applies to my Short Term Income Protection cover to:

I understand that if I wish to decrease my waiting period in the future, I will need to provide health evidence to be assessed by the insurer.

Section B: Changes to cover features

45 days 90 days

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Insurance Variation, Cancellation or Reduction (cont.)

Cancel cover

I wish to cancel the following cover (if held):

Death TPD Short Term Income Protection Long Term Income Protection

You can not hold TPD cover if you do not hold Death cover. If you request to cancel Death cover, any TPD cover you hold will automatically be cancelled, even if you do not elect to cancel this.

I understand that for any cover I have elected to cancel, I will no longer be entitled to automatic cover through Club Plus Super. If I ever wish to hold this cover in the future, I will need to provide health evidence to be assessed by the insurer.

I understand I will not be able to claim a benefi t under the cancelled cover for any insured event which occurs after the date I cancel my cover.

Reduce cover

I wish to reduce my cover to the following:

Unitised Death and TPD Cover

number of units number of units

Fixed Death and TPD cover**

$ ,000 $ ,000

*The amount of TPD cover cannot exceed the amount of Death cover**Fixed cover must be in multiple of $1,000.

Income Protection cover

$ per month (this should be 90% of your current income)

$ per month (this should be 75% of your current income)

Section C: Cancel or Reduce cover

Death

Short Term Income Protection

Long Term Income Protection

TPD*

TPD*Death

Section D: Any other instructions or questions

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Section E: Declaration

✗

Member’s signature

Date (DD/MM/YY)

• I have obtained, read and understood the insurance information in the current Club Plus Super PDS and Insurance Booklet applicable to my membership category (ie either Industry Division or Personal Division).

• I have read and understood the questions in this form.

• The answers I have provided to the questions in this form signed by me are true and correct.

• I have read the Privacy Statement at Section G of this form (The Insurer’s Privacy Policy details how the Insurer manages personal information. It is available free of charge by calling 133 667 or may be downloaded from onepath.com.au/insurance/privacy-policy.

• I consent to the collection, use, storage and disclosure of my personal information (including health and other sensitive information) as described in the Privacy Statements on this form (see Section F and G).

• I understand my duty of disclosure and the remedies available to the Insurer if I fail to comply with my duty of disclosure under the Insurance Contracts Act 1984. I understand that my duty of disclosure continues after I have completed this application until I am notifi ed in writing that my application for insurance has been accepted.

• I understand that insurance cover is provided to me on the terms contained in the Policy as changed from time to time.

• I understand that my insurance cover and premium payable will change in accordance with the direction I have made in this form from the date advised to me by Club Plus Super in writing.

• If I have chosen to cancel all or part of my insurance cover, I will no longer be insured for that cover and I (or my beneficiaries) will not be able to claim a benefi t under the cancelled cover for any insured event which occurs after the date my cover is cancelled.

• Should I wish to apply for or increase my insurance cover through Club Plus Super in the future, I will be required to provide health information to the Insurer and my insurance cover will not commence until the Insurer accepts my application for cover.

• I acknowledge that if I do not complete this form correctly or I do not sign and date this Declaration, my application will not be considered by the Insurer.

The Trustee who enters into a life insurance contract in respect of your life has a duty, before entering into the contract, to tell OnePath Life Limited (the Insurer) anything that they know, or could reasonably be expected to know, may affect the Insurer’s decision to provide the insurance and on what terms.

The Trustee has this duty until the Insurer agrees to provide the insurance.

The Trustee has the same duty before it extends, varies or reinstates the contract.

The Trustee does not need to tell the Insurer anything that:

• reduces the risk the Insurer insures you for; or• is of common knowledge; or• the Insurer knows or should know as an insurer, or• the Insurer waives your duty to tell the Insurer about.

In order for the Trustee to comply with the duty of disclosure, we require you to tell us (the Trustee and the Insurer), anything you know, or could reasonably be expected to know, that may affect the Insurer’s decision to insure you and on what terms.

If you do not tell the Trustee and Insurer something that you know, or could reasonably be expected to know, may affect the Insurer’s decision to provide the insurance and on what terms, this may be treated as a failure by the Trustee entering into the contract to tell the Insurer something that we must tell the Insurer.

If you do not tell the Insurer something

In exercising the following rights, the Insurer may consider whether different types of cover can constitute separate contracts of life insurance. If they do, the Insurer may apply the following rights separately to each type of cover.

If you do not tell the Insurer and the Trustee anything you are required to, and the Insurer would not have provided the insurance or entered into the same contract with the Trustee if you had told the Insurer and the Trustee, the Insurer may avoid the contract within 3 years of entering into it.

Duty of disclosure

Page 4 of 6


If the Insurer chooses not to avoid the contract, the Insurer may, at any time, reduce the amount of insurance provided. This would be worked out using a formula that takes into account the premium that would have been payable if you had told the Insurer and the Trustee everything you should have. However, if the contract provides cover on death, the Insurer may only exercise this right within 3 years of entering into the contract.

If the Insurer chooses not to avoid the contract or reduce the amount of insurance provided, the Insurer may, at any time vary the contract in a way that places the Insurer in the same position it would have been in if you had told the Insurer and the Trustee everything you should have. However this right does not apply if the contract provides cover on death.

If the failure to tell the Insurer is fraudulent, the Insurer may refuse to pay a claim and treat the contract as if it never existed.

Duty of disclosure (cont.)

Section F - Privacy Statement - Club Plus Super

The personal information provided on this form is collected by and held for Club Plus Super by the fund administrator AustralianAdministration Services (AAS) in accordance with the Australian Privacy Principles of the Privacy Act 1988 (Cth), for the purpose ofadministering accounts and providing services associated with your membership of the Fund.

You should read the Privacy Policy at clubplussuper.com.au/privacy-policy before completing the form. Call us on 1800 680 627 for a hard copy of the Policy. The Policy contains information about how personal information is collected, used and disclosed, how you can correct your personal information, make a complaint about a privacy breach and other important information about safeguards in place to protect your personal information.

By providing your information, you acknowledge that you have read and understood the Privacy Policy.

Page 5 of 6



In this section ‘we’, ‘us’ and ‘our’ refers to OnePath Life Limited. ‘You’ and ‘your’ refers to policy owners and life insureds.

Any reference to your personal information includes any healthor other sensitive information we may hold about you.We collect your personal information from you in order tomanage and administer our products and services. Withoutyour personal information, we may not be able to processyour application or provide you with the products or servicesyou require.

We are committed to ensuring the confidentiality andsecurity of your personal information. Our Privacy Policydetails how we manage your personal information andis available on request or may be downloaded fromonepath.com.au/insurance/privacy-policy.

We may disclose your personal information to certain thirdparties as outlined below. Unless you consent to such disclosure we will not be able to consider the information you have provided.


The parties to whom we may routinely disclose your personalinformation include:• an organisation that assists us to detect and protect against

consumer fraud• organisations performing administration and/or compliance

functions in relation to the products and services we provide• organisations providing medical or other services for the

purpose of the assessment of any insurance claim you make with us (such as reinsurers)

• our solicitors or legal representatives• organisations maintaining our information technology systems• organisations providing mailing and printing services• persons who act on your behalf (such as your agent or

financial adviser)• the policy owner (or parties acting on behalf of the policy

owner)• regulatory bodies, government agencies, law enforcement

bodies and courts• our related companies (members of Zurich Insurance Group

Ltd group), including for carrying out any group business functions

• organisations, including those in an alliance with us or our related companies, to distribute, manage and administer our products and services, carry our business functions, enhance customer service and undertake analytics activities.

We will also disclose your personal information in circumstances where we are required by law to do so.

Examples of such laws are:

• the Family Law Act 1975 (Cth) enables certain persons to request information about your interest in a superannuation fund;

• there are disclosure obligations to third parties under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006.


We may be required by relevant laws to collect certaininformation from you. Details of these laws and why they requireus to collect this information are contained in our Privacy Policyat onepath.com.au/insurance/privacy-policy

Privacy consent

Where you wish to authorise any other parties to act on yourbehalf, to receive information and/or undertake transactions,please notify us in writing.

If you give us personal information about someone else, youmust show them a copy of this document or our Privacy Policyavailable at onepath.com.au/insurance/privacy-policy so that they may understand the manner in which their personal information may be used or disclosed by us in connection with your dealings with us.

Privacy Policy

Our Privacy Policy contains information about:• when we may collect information from a third party • how you may access and seek correction of the personal

information we hold about you and• how you can raise concerns that we have breached the

Privacy Act or an applicable code and how we will deal with those matters.

You can contact us about your information or any other privacymatter as follows:

In writing: GPO Box 75 Sydney NSW 2001Email: [email protected]

We may charge you a reasonable fee for this.If any of your personal information is incorrect or has changed,please let us know by contacting Customer Services on 13 36 67.


Overseas recipients

We may disclose your personal information to recipients(including service providers and related companies) which are(1) located outside Australia and/or (2) not established in or do not carry on business in Australia.

You can find details about the location of these recipients inOnePath Life’s Privacy Policy at onepath.com.au/insurance/privacy-policy

Section G - Privacy Statement - OnePath Life Limited

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CONTACT US1800 210 098employer hotline:1800 680 627member hotline:1800 204 194pension hotline:1800 855 374Fax:Locked Bag 5007ParramattaNSW 2124

Address:

clubplussuper.com.auWeb:[email protected]:

CJ/PERS/INS/BKT 903.1 10/19 ISS13

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Documents

TOC - INDUSTRY DIVISION INSURANCE BOOKLET · for definitions not in this booklet. The information in this Insurance Booklet forms part of the Product Disclosure Statements (PDS) for