Insurance FirstChoice Super products

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1 Insurance FirstChoice Super products Personal Super Wholesale Personal Super Issue No 2013/1, dated 11 June 2013 Investments in FirstChoice Personal Super and FirstChoice Wholesale Personal Super are offered from the Colonial First State FirstChoice Superannuation Trust ABN by Colonial First State Investments Limited ABN AFS Licence

2 Contents Insurance 1 Premium rates 9 FirstChoice Rollover of Insurance Cover Form 15 FirstChoice Insurance Application Form 19 Trustee contact details Colonial First State Investments Limited 11 Harbour Street Sydney NSW 2000 Telephone Facsimile (02) this document forms part of the Product Disclosure Statement (PDS) for the following products Product name Referred to in this document as FirstChoice Personal Super FirstChoice Super products FirstChoice Wholesale Personal Super This Insurance booklet contains statements and information incorporated by reference and must be read in conjunction with the FirstChoice Super products PDS. A reference to the PDS in this booklet is a reference to the PDS, the Investment Options Menu and all statements and information incorporated by reference as described in the FirstChoice Super products PDS. Investments in FirstChoice Personal Super and FirstChoice Wholesale Personal Super are offered from the Colonial First State FirstChoice Superannuation Trust ABN ( FirstChoice or the fund ) by Colonial First State Investments Limited ABN AFS Licence ( the trustee ). The trustee or its licensed related entities to which it has delegated investment management or administration functions in relation to this product are referred to in the PDS as Colonial First State, we, our or us. FirstChoice is a resident, regulated superannuation fund within the meaning of the Superannuation Industry (Supervision) Act 1993 and is not subject to a direction not to accept contributions. An interest in FirstChoice Super products cannot be issued to you unless you use the application forms attached to or accompanied by either a paper or an electronic copy of the PDS. The offer made in the PDS is available only to persons receiving the PDS within Australia. If you are printing an electronic copy of the PDS, you must print all pages including the application forms. If you make the PDS available to another person, you must give them the entire electronic file or printout, including the application forms. A paper copy of the PDS (and any supplementary documents) can also be obtained free of charge on request by calling Investor Services on or by contacting your financial adviser. The trustee may change any of the terms and conditions contained or referred to in the PDS and, where the change is material, the trustee will notify you in writing within the timeframes provided for in the legislation. If any part of the PDS (such as a term or condition) is invalid or unenforceable under the law, it is excluded so that it does not in any way affect the validity or enforceability of the remaining parts. The insurance provider is The Colonial Mutual Life Assurance Society Limited ABN AFS Licence ( CommInsure or the insurer ). The insurance cover is provided under policies issued to the trustee by CommInsure. You can only apply for insurance cover by completing the insurance application form attached to this document. CommInsure will not make a payment under the insurance policies if the payment would cause CommInsure to be in breach of the Health Act 1973 (Cth) and/or the National Health Act 1953 (Cth). The trustee and the insurer are subsidiaries of the ultimate holding company, Commonwealth Bank of Australia ABN AFS Licence ( the Bank ). The Bank or its subsidiaries do not guarantee the performance of FirstChoice Super products, the repayment of capital by FirstChoice Super products or the insurance policies of CommInsure. Investments in FirstChoice Super products or the insurance policies of CommInsure are not deposits or other liabilities of the Bank or its subsidiaries. Investments in FirstChoice Super products are subject to investment risk, including loss of income and capital invested. However, the trustee has the benefit of a guarantee (in an approved form) limited to $5 million from the Bank in respect of the due performance of its duties as a Registered Superannuation Licensee. The guarantee is available for inspection by contacting the Company Secretary of the trustee. The information contained in the PDS is general information only and does not take into account your individual objectives, financial situation or needs. You should read the PDS carefully and assess whether the information is appropriate for you and consider talking to a financial adviser before making an investment decision. All monetary amounts referred to in the PDS are, unless specifically identified to the contrary, references to Australian dollars. FirstChoice and FirstNet are trademarks of Colonial First State Investments Limited.

3 Insurance Insurance is a very important part of your financial planning, as it provides you and your family with financial security should something unexpected happen to you. Linking insurance to your superannuation can potentially be both cost and tax-effective. Insurance cover is provided through group policies issued to the trustee by The Colonial Mutual Life Assurance Society Limited ( CommInsure or the insurer ). Types of insurance cover FirstChoice Super products offer a range of insurance cover options to suit your individual needs. These options are: Type of cover Death only Death and Total and Permanent Disablement (TPD) Salary Continuance Insurance (SCI) When is the benefit paid? A benefit is paid in the event of your death or if you become terminally ill. A benefit is paid in the event of your death or terminal illness, or if you become totally and permanently disabled. A monthly benefit is paid to you if you are disabled due to an illness or injury for longer than the nominated waiting period. Your insurance cover can be increased or reduced to meet your changing needs. It is therefore important that you review your insurance arrangements regularly. We recommend that you speak to your financial adviser before applying for insurance cover. Death cover A benefit may be payable to your beneficiaries or your estate in the event of your death. The benefit will be paid by the insurer to the Colonial First State Cash option within FirstChoice Super products. A benefit may become payable if you become terminally ill. It is payable as a pre-payment of your Death benefit. To be eligible for this benefit, you will need to provide the insurer with satisfactory medical evidence that you have less than 12 months to live. No benefit is payable if you suffer from terminal illness due to intentional self-inflicted injury or infection, or any attempt at suicide within 12 months of cover commencing, recommencing or increasing (but only the increased benefit will not be payable). If the Terminal Illness benefit is payable, your Death and TPD cover, if any, will be reduced by the amount of the Terminal Illness benefit. Total and Permanent Disablement (TPD) cover You are totally and permanently disabled if CommInsure is satisfied on medical or other evidence that as a result of illness or injury you: have been absent from your usual work for a period of three consecutive months, and have throughout that time been: unable to work (whether or not for reward) in any occupation for which you are reasonably suited by education, training or experience, and under the regular treatment, and following the advice, of a medical practitioner (a person, acceptable to the insurer, who is registered and practising as a medical practitioner in Australia, other than the insured member or a direct family member or business partner, associate, employer or employee of the insured member or a person who practises in the same medical centre or clinic as the insured member), and are likely to be so disabled for life. OR You meet the Day 1 TPD definition : You have been absent from all work as a result of suffering cardiomyopathy, primary pulmonary hypertension, major head trauma, motor neurone disease, multiple sclerosis, muscular dystrophy, paraplegia, quadriplegia, hemiplegia, diplegia, tetraplegia, dementia or Alzheimer s disease, Parkinson s disease, blindness, loss of speech, loss of hearing, chronic lung disease or severe rheumatoid arthritis; and in the insurer s opinion are so disabled for life and unlikely to ever be able to engage in any occupation whether or not for reward, where occupation means an occupation that you can perform on a full-time or part-time basis, based on the skills and knowledge you have acquired through previous education, training or experience. 1 OR You have suffered the permanent loss of the: use of two limbs, or sight in both eyes, or use of one limb and the sight in one eye, where a limb means an entire hand or an entire foot. TPD cover while in full-time domestic duties or child rearing If you have been engaged in full-time domestic duties or child rearing at the time of the illness or injury that causes TPD, CommInsure will only pay a TPD benefit if satisfied on medical or other evidence that as a result of illness or injury you: have been unable to perform domestic duties or child rearing and you have been confined to the home for a period of six consecutive months are under the regular treatment, and following the advice, of a medical practitioner (a person, acceptable to the insurer, who is registered and practising as a medical practitioner in Australia, other than the insured member or a direct family member or business partner, associate, employer or employee of the insured member or a person who practises in the same medical centre or clinic as the insured member) 1 The medical ailments listed are as defined in the Policy Document, which is available on request. Insurance 1

4 continue to be so incapacitated to the extent that you are unable to engage in any occupation (whether or not for reward) for which you are reasonably suited by education, training or experience, and will be so disabled for life. OR You have suffered the permanent loss of the: use of two limbs, or sight in both eyes, or use of one limb and the sight in one eye, where a limb means an entire hand or an entire foot. If you have had your cover automatically transferred from FirstChoice Employer Super or you have transferred cover from an external fund, and have not been working or have been employed for less than 15 hours per week on a regular basis or on home duties for the six months prior to the event, you may be entitled to a TPD benefit if the insurer is satisfied that you will never be able to perform at least two of the following activities of daily living without assistance of another person: dressing, toileting, feeding, control bowel and bladder function or get in and out of bed and a chair. If the TPD benefit is payable, your Death and Terminal Illness benefit will be reduced by the amount of TPD benefit. Salary Continuance Insurance (SCI) cover SCI provides you with a monthly benefit if you are totally disabled due to sickness or injury for longer than the waiting period that applies to you. SCI also provides you with a proportion of the monthly benefit if you are partially disabled for longer than the waiting period as explained below. The benefit will start to accrue after the nominated waiting period (30 or 90 days) has ended and will continue while you remain disabled for the benefit period. The benefit period is a benefit payable for a maximum of either two years, five years or until you reach age 65. Totally disabled for SCI cover You are totally disabled if you suffer from a sickness or injury and as a result you are: unable to perform at least one income producing duty of your normal occupation, and not working, and under the regular care of a medical practitioner. An income producing duty is a duty of your normal occupation that generates at least 20% or more of your monthly income. Normal occupation means the normal occupation or work carried out by you immediately before becoming disabled. You must be totally disabled for at least 14 out of the first 19 consecutive days of the waiting period to qualify for a total disability benefit. Partially disabled for SCI cover You are partially disabled if you are not totally disabled, but due to sickness or injury: you are unable to work in your normal occupation at full capacity you are working in your normal occupation in a reduced capacity, or working in another occupation your monthly income is less than your pre-disability income, and you are under the regular care of a medical practitioner. Pre-disability income is the average monthly income you earned from any occupation during the 12 months immediately before your most recent period of disability. You must be totally disabled for at least 14 out of the first 19 consecutive days of the waiting period to qualify for a partial disability benefit. Please note: No benefit is payable during the waiting period, which is either 30 or 90 days from the date on which you become disabled. If you have been totally disabled throughout the waiting period and then return to work in a reduced capacity and you are earning 20% or less than your pre-disability income, a total disability benefit rather than a partial disability benefit will be paid for up to three months. If, after the total disability benefit is paid and you are still partially disabled, you will be paid the partial disability benefit while you remain partially disabled for the benefit period. If you are partially disabled after the waiting period has ended, a proportion of the monthly benefit is payable based on the reduction in your pre-disability income. If you become unemployed or go on leave without pay while a partial disability benefit is payable, the maximum benefit we will pay is 60% of the total disability benefit that would have been payable had you been totally disabled. Return to work during the waiting period If your waiting period is 30 days, you can return to work at full capacity for a total of five days before the waiting period will start again. If your waiting period is 90 days, you can return to work at full capacity for a total of 10 days before the waiting period will start again. However, the waiting period will be extended by the number of days worked. Recurrent disability If you become totally or partially disabled again from the same or a related sickness or injury within six months of the end of payment of a disability benefit, a new waiting period will not apply and the disability will be treated as a continuation of the original claim and original benefit period, provided the entitlement to the disability benefit does not otherwise end. Cover while unemployed or on leave SCI cover will continue if you become unemployed, or go on leave without pay, as long as your premium payments are made. However, different definitions of total disability and partial disability may apply. If you have been unemployed or on maternity, paternity or long service leave for 12 months or more immediately before making a claim, then you are only totally disabled if because of sickness or injury you are: 2 FirstChoice Super products

5 unable to perform any occupation for which you are reasonably suited by education, training or experience not working, and under the regular care of a medical practitioner. If you become unemployed or go on leave without pay while a partial disability benefit is payable, then to determine whether you are still partially disabled CommInsure must be satisfied that you are not totally disabled and that because of sickness or injury: you are only capable of working in your normal occupation in a reduced capacity, or working in another occupation the monthly income you are capable of earning from any occupation for which you are reasonably suited by education, training or experience would be less than your pre-disability income, and you are under the regular care of a medical practitioner. What is your monthly benefit? Your monthly benefit is the lesser of: $25,000 per month the amount of SCI cover which you have applied and been accepted for including any increases, or the insured percentage of your total monthly income during the 12 months immediately before your most recent period of disability. Insured percentage means the percentage of your monthly income for which you are insured, up to 85% (this includes a 10% allowance for superannuation contributions). Importantly, your premiums are calculated on your accepted amount of cover. If, at claim time, your monthly income means your monthly benefit will be less than your accepted amount, you will not be refunded for the excess premiums you have paid. Therefore, it is important that you notify us if your income changes to avoid paying premiums for benefits to which you will not be entitled. If you are self-employed, a working director or a partner in a partnership, your monthly income is the monthly income generated by the business or practice directly due to your personal exertion or activities, excluding superannuation, less your monthly share of necessarily incurred business expenses. If you are not self-employed, a working director or a partner in a partnership, your monthly income is the total value of remuneration paid by your employer, including salary, fees, commission, bonuses, regular overtime and fringe benefits, but excluding superannuation. Where included, bonuses will be averaged over the preceding three years. Your monthly benefit will be treated as income (including the Superannuation Guarantee component) and tax will be deducted before it is paid to you. When does the monthly benefit end? The insurer will pay the monthly benefit until the first of the following occurs: you are no longer totally or partially disabled (as applicable) the benefit period ends your 65th birthday, or your death. Continuation of cover after claim In the event that your monthly benefit ceases because you: are no longer totally or partially disabled (as applicable), or reach your maximum benefit period of two years or five years, you will continue to be covered for SCI, and premium deductions will recommence. You will not be able to make a further claim under this policy for the same condition that led to your original claim. If you have not returned to gainful employment, you may not receive a monthly benefit under this policy for any other condition. If you return to gainful employment in the future, you may be able to claim again under this policy. Benefit offsets CommInsure will reduce your monthly benefit if for the same period of disability you receive other payments which exceed, in total, 10% of your pre-disability income and such payments are received in connection with: a workers compensation or motor accident claim or any claim under similar State or Federal legislation sick leave social security benefits or other legislated income benefits, or any insurance that provides income benefits for sickness or injury. Any such payment which is in the form of a lump sum or is exchanged for a lump sum will have a monthly equivalent value of 1/60th of the lump sum over a period of 60 months. If you are totally disabled and continue to receive part of your income from your employer, this income is deducted from the benefit the insurer pays. The insurer will only pay benefits for one sickness or injury at a time. The insurer will not pay a benefit for the same period for which an income protection benefit is payable to you under FirstChoice Employer Super. How to apply For new cover, you will need to complete the insurance application form on page 19. Depending on your age, health and medical history and the amount of insurance cover sought, you may need to provide further health evidence or complete certain additional tests in order for CommInsure to assess your application for insurance cover. If you hold an existing insurance policy within another superannuation account, our insurer may agree to waive underwriting requirements to provide the same amount of cover under your FirstChoice Super products account. To roll over an existing insurance policy, you must cancel your original policy within 60 days of cover being provided under FirstChoice Super products. Please note: Once your cover has been accepted, you will only be entitled to claim under one of these policies. Otherwise, full underwriting requirements will not be waived and cover will not be provided. Please note: FirstChoice Super products premiums, terms and conditions will apply and may be different to your existing cover. You should read the PDS for both products and decide whether cover under FirstChoice Super products is suitable for your personal circumstances. Refer to our rollover of insurance cover form on page 15. Insurance 3

6 Once your application has been accepted by CommInsure, we will confirm in writing the amount of cover with which the insurer has agreed to provide you. CommInsure may accept an application for cover or an increase in cover subject to premium loadings and non-standard terms. You will be notified if this is the case. Can you change your insurance? You can apply to change the type of insurance and the level of cover at any time by writing to us. When does your cover commence? Your application for insurance cover will need to be assessed by CommInsure. Your insurance cover will commence when: the insurer has accepted your application for insurance, and your account balance in FirstChoice Super products is sufficient to cover the monthly insurance premiums. You will be notified in writing of CommInsure s assessment of your application and, if it is accepted, the date that your insurance cover or increase in cover commences. How much does your insurance cover cost? Insurance premiums depend on the type of cover you choose and the level of cover you require. The premium may also be affected by your age, gender, occupation, health, whether or not you smoke and any sporting or recreational activities in which you may participate. You can estimate the monthly premium using the premium rate tables on pages 10 to 13. Premiums are based on age next birthday and the rates applicable, at your insurance anniversary date. To give you an idea of where your occupation might fit, we have provided examples of occupations that fall within the respective categories. These occupation group examples apply as at 11 June 2013 and are intended as a guide for applicants, and may change at any time. Occupational examples Professionals White collar Light blue collar Blue collar Not eligible Occupations of a professional nature. To qualify in this category, you must satisfy the following: earn a salary greater than $80,000 pa, and only work in an office environment in an occupation that requires no manual work. Occupations that require no manual work and do not satisfy the professional definition. For example, clerical, administration, managerial and sales roles not involved in any deliveries or travelling. Occupations that involve up to 20% manual activity. For example, retail sales representatives, or supervisors of manual workers who do not perform any manual work themselves. Occupations that involve more than 20% manual work. For example, cleaning, lifting over 5kg, carpentry, plumbing, etc. These would include all trades people, delivery drivers, mechanics, etc. Occupations that are determined as hazardous or other occupations for which the insurer will decline to provide cover. For example, underground miners, explosives handlers, professional sports persons. Making a claim We must be notified in writing as soon as possible after you become aware of any claim or potential claim. A waiting period may apply. You must provide CommInsure with any requirements it reasonably considers are necessary to properly assess the claim. Payment of a Terminal Illness, disability or TPD benefit is conditional on you undergoing any medical or other examination which CommInsure reasonably requires. If a claim for a Death, Terminal Illness or TPD benefit is accepted, that benefit will be paid by the insurer to the Colonial First State Cash option within FirstChoice Super products. Any TPD or Terminal Illness benefit can only be paid to you if you meet a condition of release as set out under superannuation law. Please note: If you make a TPD claim, your Death cover will be reduced by this amount. If you do not qualify for the day 1 TPD definition, there is a three-month waiting period for TPD benefits from the date of the event, provided your claim is approved by our insurer. The insurer will generally pay the costs of any medical examination or medical report that it requests other than the initial examination or reports required to make a claim. The insurer will, however, not pay for any other costs such as costs incurred for travelling to an appointment or for non attendance at an arranged appointment (including costs involved in returning to Australia, if overseas). An SCI claim and a TPD claim can both be paid if the conditions for each are met. Please note: The payment of the insured amount is subject to the acceptance of your claim by the insurer. Indexation Your Death and TPD cover (up to $1 million) are automatically indexed to the Consumer Price Index (a measure of inflation) each year on the anniversary of the commencement of your insurance cover. Indexation is based on the percentage increase in the Consumer Price Index (up to a maximum of 7.5% pa). Your premiums will increase due to this indexation since your insurance cover will increase. If you do not want your insurance cover automatically indexed each year, please advise us in writing. For SCI cover with a benefit period of five years or to age 65, the monthly benefit will be indexed to the Consumer Price Index (subject to a maximum of 7.5%) one year after the SCI benefit commenced and annually thereafter, up to the product maximum of $25,000 per month. 4 FirstChoice Super products

7 Summary of eligibility criteria, cover limits, cover ceasing and exclusions Death cover TPD cover SCI cover Eligibility To be eligible for cover, you must be: an investor in FirstChoice Super products aged less than 75 years. To be eligible for cover, you must be: an investor in FirstChoice Super products aged less than 60 years gainfully employed for more than 15 hours per week on a regular basis or engaged in full-time domestic duties or child rearing. Cover is not available to casual employees. To be eligible for cover, you must be: an investor in FirstChoice Super products aged less than 60 years employed on a permanent basis to carry out identifiable duties, actually performing those duties at least 15 hours per week and being capable of performing those duties at least 35 hours per week. Cover is not available to casual employees. Other conditions For investors who automatically transfer from FirstChoice Employer Super, TPD cover will continue under FirstChoice Personal Super if you are aged less than 65 years. For investors who automatically transfer from FirstChoice Employer Super, cover will continue under FirstChoice Personal Super if you are aged less than 65 years. Cover is not available to temporary residents. Cover details Minimum cover No minimum No minimum No minimum Maximum cover $5 million $3 million 85% of monthly income (this includes a 10% allowance for superannuation). When does cover cease? What exclusions apply? 1 The earliest of the following: the end of the premium month following your 75th birthday your account balance is not sufficient to cover monthly premiums and 90 days have elapsed you cease to be an investor in FirstChoice Super products we receive your request to cancel cover the policy which provides your cover is terminated your death a Terminal Illness or TPD benefit is paid which reduces the Death benefit to nil you commence active duty with the armed forces of any country. Benefit will not be paid in the case of: suicide or intentional self-inflicted injury or infection (whether sane or not at the time) within the first 12 months after the date that the commencement, recommencement, or increase of cover is approved by the insurer (in the case of increase, only the increased portion will not be paid), or pandemic illness where a pandemic illness has been declared, the insurer will not pay a benefit if the member dies, or is terminally ill, directly or indirectly because of the pandemic illness or other condition caused by or related to the pandemic illness in any way and the death, or terminal illness, is within 30 days of your cover starting, recommencing or increasing. Please note: Your TPD cover amount cannot exceed your Death cover amount. The earliest of the following: the end of the premium month following your 65th birthday your account balance is not sufficient to cover monthly premiums and 90 days have elapsed you cease to be an investor in FirstChoice Super products we receive your request to cancel cover the policy which provides your cover is terminated your death a Terminal Illness or TPD benefit is paid which reduces the Death benefit to nil a TPD benefit becomes payable you commence active duty with the armed forces of any country. Benefit will not be paid in the case of: attempted suicide or intentional selfinflicted injury or infection (whether sane or not at the time), or war, including any act of war (whether declared or not). Please note: This is subject to a maximum cover of $25,000 per month. The earliest of the following: the end of the premium month following your 65th birthday your account balance is not sufficient to cover monthly premiums and 90 days have elapsed you cease to be an investor in FirstChoice Super products we receive your request to cancel cover the policy which provides your cover is terminated your death you commence active duty with the armed forces of any country you exercise the continuation option. Benefits will not be paid if a sickness or injury is directly or indirectly caused by: any attempt at suicide or intentional self-inflicted injury or infection (whether sane or not at the time) war, including any act of war (whether declared or not), revolution, invasion, civil war or rebellion in which Australia is involved, or normal and uncomplicated pregnancy or childbirth including multiple pregnancy, Caesarean birth, threatened miscarriage, postnatal depression, participation in an IVF or similar program and normal discomforts commonly associated with pregnancy such as morning sickness, backache, varicose veins, ankle swelling and bladder problems, unless the insured member is disabled for more than 90 days after the end of the pregnancy (in which case the waiting period is deemed to start on the later of the date total disablement begins and the end of the pregnancy). 1 The payment of insurance benefits is also subject to any special conditions or exclusions that may apply to you. Insurance 5

8 What happens if you leave FirstChoice Super products? If you leave FirstChoice Super products at any time and no insured benefit has been paid or is payable, then you may apply with limited evidence of health to continue that cover by taking out an individual life insurance policy with the insurer. The level of cover under an individual life insurance policy will be the level of your cover you held as at the date you leave FirstChoice Super products. An individual policy will be issued on the terms and at the premium rates current when the policy is issued. However, it will be subject to any minimum policy requirements, non-standard terms, premium loadings or exclusions that apply under your FirstChoice Super products cover. To take advantage of the continuation option, you must apply within 45 days of your cover ceasing and you must be less than age 60. An insured member who exercises the continuation option is not eligible for future cover under FirstChoice Super products, unless they reapply for insurance cover and the application is accepted. If your Death and, if applicable, TPD cover ceases and you are eligible to exercise the continuation option for that cover, the insurer will pay a benefit if you die, suffer a terminal illness or become totally and permanently disabled within 45 days of your cover ending, but before you exercise the continuation option. If your SCI cover ceases and you are eligible to exercise the continuation option for that cover, CommInsure will pay a benefit if you become totally disabled or partially disabled within 45 days of your cover ending, but before you exercise your continuation option. The benefit will be paid provided you remain disabled for longer than the waiting period and it will only be paid for two years. Cooling-off period You have a 28-day cooling-off period to review your cover, during which you can elect to cancel your cover in writing, and any premiums paid will be refunded. The 28 days will apply from the earlier of the: date on which you receive our written confirmation of cover, or end of the fifth day after the day on which our confirmation is issued. If your application was for additional cover, the cooling-off period applies to the increased portion of insurance cover only. Amounts that are, or become, preserved or restricted non-preserved cannot be refunded directly to you if you take advantage of the 28-day cooling-off period (unless you satisfy a condition of release). Insurance policy The information about insurance is general in nature, and the payment of a benefit is subject to the terms of the relevant life insurance policies between us and CommInsure. We will not make any payment greater than the amount actually received from CommInsure. If a benefit is payable by CommInsure under a policy, the benefit will be paid to us and then paid in accordance with preservation rules and the trust deed. We can, by agreement with CommInsure, vary the contractual arrangements for insurance at any time. You will be notified of any variation which affects you. Increasing your cover without medical evidence under a life event option When you experience one of the following life events, you can apply to increase your existing Death and TPD or Death-only cover without having to provide additional medical evidence. Some documentation will be required as outlined in the table below. Please note: You cannot increase SCI cover under the life events option. Event Marriage Birth or legal adoption of a child (does not include assuming parental responsibilities for a step-child or becoming a legal guardian) Mortgage or refinance your primary residence Child s first day at primary or secondary school Divorce Death of spouse What documents are needed? Marriage certificate Birth certificate OR adoption documentation Stamped front page of the contract of sale (or refinance contract) AND letter on bank letterhead detailing the loan arrangement Letter on school letterhead confirming the name of the student, school start date and details that the student is starting either Primary (Kindergarten) or Secondary (Year 7) Decree Nisi/Absolute OR Certificate of Divorce Death certificate To be eligible to apply for an increase in cover under the life events option, you will need to meet the following conditions: existing Death only or Death and TPD cover, and we must receive your application for cover (including documentary evidence supporting the life event) within 120 days of the life event. You are not eligible for the life events cover option if your cover ends or you die, become terminally ill or become totally and permanently disabled before we receive your application. To apply to increase cover under a life events option, complete the life events insurance cover option form available from our website. How much increased cover can you apply for? Under the life events cover option, you can apply to increase your existing insurance cover by up to (i) $250,000 or (ii) 100% of your existing cover, whichever is the lesser amount. If you have Death and TPD cover, you must apply to increase both components of the cover, ie you cannot increase the Death component but not the TPD component. Additional cover under the life events cover option is provided as a fixed dollar amount, on top of your existing level of cover. Your increased level of cover will commence on the date we receive written notification and documentary evidence and provided it is subsequently accepted by the insurer. Any exclusions, loadings or other restrictions that apply to your existing cover will also apply to the increased portion of cover. Your monthly insurance premium will change based on your new level of cover (once accepted by the insurer). How often can you increase cover under life events? You may exercise the life events cover option more than once (except for the mortgage/refinancing option, which can only be exercised once), but there must be at least a 12-month gap between applications to increase cover. 6 FirstChoice Super products

9 Important additional information Accidental cover Death and TPD If you have sufficient funds to meet the minimum balance requirements, the insurer will provide accidental death cover and, if applicable, TPD cover while an application for cover or an increase in cover is being assessed. A lump sum is provided based on the level of cover applied for (subject to a maximum of $1 million for Death and TPD). Cover is provided from the date on which an application for Death or TPD cover is received by CommInsure until the earliest of: the date on which your application is accepted or declined the date on which your application is withdrawn 120 days from the date on which CommInsure receives your application the date on which CommInsure cancels the cover, or the date on which a benefit becomes payable. A benefit is payable only once, for either accidental death or TPD but not both. In the case of accidental TPD, CommInsure will apply the definition of TPD which would have applied to you had you been accepted for TPD cover, but the disablement must be the result of an accident. No benefit is payable if death is the result of suicide, or intentional self-inflicted injury or infection, whether or not you are sane at the time. No benefit is payable if TPD is caused directly or indirectly by war (whether declared or not) or by intentional self-inflicted injury or infection or attempt at suicide, whether or not you are sane at the time. Salary Continuance Insurance (SCI) If you have sufficient funds to meet the minimum balance requirements, the insurer will provide accidental disability cover while an application for cover or an increase in cover is being assessed. A monthly benefit is provided based on the level of cover applied for or the increase in cover applied for (subject to a maximum benefit of $15,000 per month). Cover is provided from the date on which an application for SCI cover is received by CommInsure until the earliest of: the date on which your application is accepted or declined the date on which your application is withdrawn 120 days from the date on which the insurer receives your application the date on which CommInsure cancels the cover the date on which a benefit becomes payable your death your 65th birthday the date you cease to be an investor in FirstChoice Super products, or for an application to increase cover, the date your cover ceases for any of the reasons outlined on page 5. The monthly benefit is paid if, while the interim cover applies, you suffer from accidental total disability and that disability continues after the waiting period selected in the application. The benefit will be paid until the first of the following occurs: you are no longer accidentally totally disabled six months after the end of the relevant waiting period your death, or your 65th birthday. The monthly benefit is only payable once for each application. If you are eligible for an accidental disability benefit, your application may still be accepted. However, your change in health may be taken into account and your application may be declined or accepted on non-standard terms or with a premium loading. Where relevant, the exclusions (see page 5) and benefit offsets (see page 3) which apply to SCI also apply to the interim accidental disability cover. Worldwide cover The insurer provides cover 24 hours a day anywhere in the world, subject to the conditions of the cover. Reduction of benefits When a Death benefit becomes payable, all other cover ceases. If a Terminal Illness benefit becomes payable, the Death benefit and, if applicable, the TPD benefit will be reduced by the amount of Terminal Illness benefit payable. If a TPD benefit becomes payable, the Death benefit and Terminal Illness benefit will be reduced by the amount of TPD benefit payable. What if your insurance cover lapses? If your Death, TPD or SCI cover lapses due to non-payment of premiums, it may be reinstated within 12 months of your cover ceasing. You will need to complete a new insurance application form and provide satisfactory health evidence to the insurer. Insurance cover will only recommence when your new application is accepted by the insurer and all premiums are paid. Special offers From time to time, we may agree with the insurer to make available special offers in relation to insurance for existing or prospective members. Such special offers could include reduced premium rates or changes to the underwriting rules, and may apply only to a limited range of investors. Important information about rollover of insurance How is your cover applied when rolled into FirstChoice? The way your cover will be applied depends on whether you are rolling Death and TPD cover or SCI cover, as follows: Death and TPD your total cover will be equal to the sum of any existing cover within FirstChoice Super products and the amount of cover transferred from your former fund or policy (subject to a maximum total cover of $1.5 million including any existing cover). Example: FirstChoice cover $150,000 death only + former fund cover $100,000 death only = new FirstChoice cover $250,000 death only. SCI your total cover will be the greater of any existing cover within FirstChoice Super products and the amount of cover held under your former fund (subject to a maximum cover of $10,000 per month). Example: FirstChoice cover $4,000 per month, former fund cover $7,500 per month = new FirstChoice cover $7,500 per month. Insurance 7

10 Do you need to have been previously underwritten in order to transfer your cover? No. Your existing cover may have been obtained either through underwriting or automatically, for example, through an employersponsored superannuation plan arrangement. What aspects of existing cover transfer? When cover is rolled to FirstChoice, you receive an equivalent sum insured as outlined above. Any exclusions and loadings that applied to the cover under the former fund will also apply under FirstChoice. FirstChoice Super products premiums, terms and conditions will apply and may be different to your existing cover. Can you roll different types of cover into FirstChoice? We allow rollover of like-for-like cover (subject to product restrictions and eligibility rules). For example, if you have Death and TPD cover with your former fund, you must roll in all Death and TPD cover. If we decline the TPD cover, then the rollover of cover for both Death and TPD is declined. Can you roll over partial cover? We allow rollovers of partial cover, provided the cover is like for-like. What happens at the time of the claim if you didn t cancel your previous policy? You will not be entitled to claim on the portion of cover rolled over to FirstChoice. What waiting period will apply to your SCI cover? When you roll cover to FirstChoice Super products, the waiting period applied to your SCI cover will be: 30 days, if it was 30 days or less with your former fund 90 days, if it was greater than 30 days but less than 120 days with your former fund. A full personal statement will be required, if the waiting period is greater than 120 days, to be considered for either a 30-day or a 90-day waiting period. What benefit period will apply to your SCI cover? The benefit period that will apply to your SCI cover is: two years, if it was two years five years, if it was five years and up to age 65 to age 65, if it was to age 65. Does this form allow you to roll over your super as well? You need to complete an application form for your chosen FirstChoice Super product if you don t already have an active account, or complete an additional application form if you are already an investor. Is there a limit to what insurance you can roll to FirstChoice? You are able to roll multiple superannuation account balances and associated insurance policies to FirstChoice, subject to our product maximums. You can also roll over retail insurance policies. The following conditions apply to the amount of cover that can be rolled over: members must be under the age of 55 years you have not received nor are you eligible for a TPD benefit you must meet the eligibility criteria for cover you must transfer the entire balance of your previous fund to FirstChoice Super products you have not been diagnosed with an illness that reduces your life expectancy to less than 12 months SCI is limited to a maximum of $10,000 per month Death only or Death and TPD is limited to $1.5 million total cover being held in FirstChoice Super products. Please note: You cannot transfer existing benefits from a corporate arrangement. Occupational class and eligibility We will assess your current occupational rating. If your occupational class is considered high risk by our insurer, eg pilots, miners, armed forces etc, a blue collar classification will be applied to your Death cover and, in some cases, you may not be eligible to transfer your TPD and SCI cover. If you are unemployed, you can only transfer Death and TPD cover (Activities of Daily Living definition will apply). What if cover is transferred from another FirstChoice product or the Colonial First State Rollover & Superannuation Fund? If you are transferring cover from another FirstChoice product or the Rollover & Superannuation fund, you do not need to satisfy the eligibility criteria. This will be considered a continuation of cover. Terms and conditions and premiums may vary from your previous policy. What is a valid statement? You will need to provide proof of existing cover by providing a valid statement from the former fund, or the insurer of the retail insurance policy, which is dated within the last six months or a Certificate of Currency, on company letterhead, or an adviser generated portfolio report. The statement needs to clearly outline the existing insurance cover held. 8 FirstChoice Super products

11 Premium rates Please note: The premium rates in the tables on pages 10 to 13 apply to new members who join on or after 11 June They may also apply to some members who joined prior to this date. Please call us on to confirm which premium rates apply to you. The pre 11 June 2013 premium rates are available on our website, colonialfirststate.com.au/fcps (Personal Super) or colonialfirststate.com.au/fcwps (Wholesale Personal Super). How do you estimate your annual premium? Death and TPD To estimate the annual premium applicable to you, find the premium rate applying to you from the table on page 10, taking into account your gender, age next birthday and whether you smoke or not, then apply the occupational loading factors to the cover, if applicable. Then perform the following calculation: [(Death premium rate Death occupational factor) + (TPD premium rate TPD occupational factor)] insurance cover $1,000 Example For a non-smoker male light blue collar worker, who will be 36 next birthday, seeking $500,000 Death and TPD cover, the annual premium is estimated to be: = $( ,000) $1,000 = $ per annum Please note: The Death and TPD rate was calculated by (0.57 1) + ( ) = 1.02 (where 1.50 is the TPD occupational loading factor for light blue collar). The above calculation is only an estimate. You will be advised in writing of the actual premium and commencement of insurance cover depending on your personal circumstances. The insurer may apply a premium loading, exclusions or other special conditions to any insurance cover which it accepts. We will notify you in writing if this applies. For more information on occupation categories, please call Investor Services on or speak to your financial adviser. SCI To calculate the annual cost of your SCI cover, find the premium rate applying to your age at your next birthday and benefit period from the tables on pages 11 to 13. Then perform the following calculation: Premium rate insurance cover SCI occupational $100 loading factor Example For a non-smoker female white collar worker who will be 40 next birthday, seeking $4,000 of SCI cover per month for a two-year benefit period and with a 90-day waiting period, the annual premium is estimated to be: Will your premiums change? Once you are insured, CommInsure will not increase your premium because of any change to your health, occupation or lifestyle. However, if you apply to increase your cover, CommInsure will take into account changes to your health, occupation or lifestyle and, if your application is accepted, CommInsure may apply a different premium to the increased portion of your cover. Premiums generally increase annually in line with your age. Premium rates can be varied by CommInsure by providing prior notice. If the insurer does not receive your premium within 90 days after its due date, your cover will cease. If you make a claim under SCI and a disability benefit is payable, your monthly premiums will be waived from the end of the waiting period until the disability benefit ceases to be payable. How are your premiums paid? Insurance premiums are payable in advance and deducted monthly from your account in FirstChoice Super products. You can select the investment option from which you want the premium to be deducted. You must ensure that the balance of the nominated option is sufficient to cover premiums at all times, as insufficient funds may cause your cover to lapse. If no option or an invalid option is nominated, we will generally deduct your premium from the more conservative option invested in, as outlined below. If the deduction of your monthly insurance premium will cause your investment balance to fall below the required minimum of $1,500, the investment may be transferred to an Eligible Rollover Fund. If this occurs, you will no longer be a member of the fund and your insurance cover will cease immediately. You will be advised in writing before this takes place. Please note: Choosing FirstRate Term Deposit products or FirstRate Investment Deposit investment options for premium deductions will be an early withdrawal and reduce the interest you receive; refer to the Reference Guide Transacting on your account. Default order for deduction of premiums Please note: Where amounts, for example, insurance premiums or adviser service fees, are to be deducted from or credited to your investment, and no option or an invalid option has been nominated by you, a default order exists. Generally, the default order draws from or credits to your more conservative option, as determined by us. Special rules may apply where you hold FirstRate Term Deposit products or FirstRate Investment Deposit options. Please call Investor Services on should you require further information. = $(8.15 x 4,000) 1.00 = $326 per annum $100 Insurance 9

12 Premium rates Death and TPD Annual premium rate table (per $1,000 sum insured) Age next birthday Male Female Death only ($) White collar TPD ($) Death only ($) White collar TPD ($) Non-smoker Smoker Non-smoker Smoker Non-smoker Smoker Non-smoker Smoker Rates in bold are not applicable to new applicants, and are only available for rate renewals. TPD cover is not available past age 65. Premium rates shown include a Colonial First State administration fee of 10%. Premium rates include stamp duty. Occupational loading factors Death TPD Professionals White collar Light blue collar Blue collar FirstChoice Super products

13 Premium rates SCI Annual premium rate table (per $100 monthly benefit, two-year benefit period) Age next birthday Male Female Male Female 30-day wait 30-day wait 90-day wait 90-day wait Non-smoker Smoker Non-smoker Smoker Non-smoker Smoker Non-smoker Smoker Premium rates shown include a Colonial First State insurance administration fee of 10%. Rates in bold are not applicable to new applicants, and are only available for rate renewals. SCI is not available past age 65. Premium rates include stamp duty. SCI occupational loading factors Professionals 0.90 White collar 1.00 Light blue collar 1.90 Blue collar 3.10 Insurance 11

14 Premium rates SCI Annual premium rate table (per $100 monthly benefit, five-year benefit period) Age next birthday Male Female Male Female 30-day wait 30-day wait 90-day wait 90-day wait Non-smoker Smoker Non-smoker Smoker Non-smoker Smoker Non-smoker Smoker Premium rates shown include a Colonial First State insurance administration fee of 10%. Rates in bold are not applicable to new applicants, and are only available for rate renewals. SCI is not available past age 65. Premium rates include stamp duty. SCI occupational loading factors Professionals 0.90 White collar 1.00 Light blue collar 1.90 Blue collar FirstChoice Super products

15 Premium rates SCI Annual premium rate table (per $100 monthly benefit, benefit period to age 65) Age next birthday Male Female Male Female 30-day wait 30-day wait 90-day wait 90-day wait Non-smoker Smoker Non-smoker Smoker Non-smoker Smoker Non-smoker Smoker Premium rates shown include a Colonial First State insurance administration fee of 10%. Rates in bold are not applicable to new applicants, and are only available for rate renewals. SCI is not available past age 65. Premium rates include stamp duty. SCI occupational loading factors Professionals 0.90 White collar 1.00 Light blue collar 1.90 Blue collar 3.10 Insurance 13

16 This page has been left blank intentionally. 14 FirstChoice Super products

17 Colonial FirstChoice State FirstChoice Employer Super Investor Rollover Selected of Insurance Insurance Cover Form Application Form B3AHFM 11 June 2013 This form is to be completed for applications to roll over insurance from an external superannuation policy. Do not cancel your existing insurance cover or transfer any funds until you have received confirmation in writing that your request has been accepted by FirstChoice Super products. I have attached an up-to-date statement from my former fund confirming the type, level and additional terms of my existing cover. My statement is dated within the last six months. You can apply to roll over insurance cover that you have outside of FirstChoice Super products if you are: joining FirstChoice Super products for the first time or are an existing member of FirstChoice Super products, and you have insurance cover under an existing superannuation fund ( former fund ) and are transferring the account balance of that former fund to FirstChoice Super products, by 1 completing PARTS A, B and C of this form, providing all the required details and signing and dating the Duty of Disclosure section of this application form, and 2 attaching the most recent statement from your former fund confirming the type and level of cover you have with the former fund (if your cover has changed since your most recent statement was issued, you will need to provide an up-to-date statement), and 3 attaching an application form or additional application form with details of your former fund and the balance to be transferred. If FirstChoice s insurer, The Colonial Mutual Life Assurance Society Limited ABN AFS Licence (CommInsure) accepts your application, you will receive an amount of cover equivalent to the level of cover you currently have with your former fund. Refer to Important information about rollover of insurance on pages 7 and 8. Please note that acceptance of your request is subject to the insurer s acceptance and some limitations apply. Please complete this form using BLACK INK and print well within the boxes in CAPITAL LETTERS. Start at the left of each answer space and leave a gap between words. Part A Personal Details 1 Insured details Existing account number (if known) Date of birth (Maximum entry age is 55) / / Title Gender Mr Mrs Miss Ms Other Male Female Given name(s) Surname Postal address Unit number Street number PO Box Street name Suburb State Postcode Country Name of employer Name of former fund Former fund member number Former fund SPIN (if known) Please note: You need to complete a separate Rollover of Insurance Cover form for each policy you are rolling over. Insurance 15

18 Part A Personal Details (continued) 1 Insured details (continued) 1 What is the main occupation you are currently working in? Main occupation Industry Self-employed? Hours per week? No/ No/ Full-time Part-time Casual Unemployed Contractor Annual salary (including average bonus for last three years) $,, Please select the income producing duties of your main occupation and the approximate percentage of time spent on each duty per week. Note: The list below represents the physical nature of duties only. Do not write or add to these descriptions. Nature of duty % time Administrative/Clerical (eg filing, computer work, office duties, etc) % Light manual work only (eg driving with deliveries, lifting under 5kg, etc) % Supervisor of manual work (not actual performance) % Caring for dependants (only for TPD and if occupation is home duties ) % Manual work (eg cleaning, lifting over 5kg, carpentry, plumbing, etc) % Flying (other than as a fare paying passenger) or fly-in fly-out rotation on job site % Truck driving greater than a distance of 800km from base; working above 15 metres; working underground; % working at sea or handling explosives Total 100% 2 Have you smoked tobacco or any other substance at any time during the last 12 months? No 2 deduction of premiums Please select the investment option from which you want your premiums to be deducted. Please note: Choosing FirstRate Term Deposit or FirstRate Investment Deposit options for the deduction of insurance premiums will create early withdrawals. We recommend you choose other investment options if available. Indicate only one option (if you have an adviser service fee, this should be the same option). If no option or an invalid option is nominated, we will deduct your premium from the more conservative option (with a sufficient balance), as outlined on page 9. PART B PERSONAL STATEMENT AND CONFIRMATION OF REQUIREMENTS In order to apply for a rollover of insurance cover, you must be able to answer to question 1. 1 Do you confirm that the following statements are true and correct and agree to abide by these requirements? a I confirm that my existing cover is arranged through an external superannuation fund (not a self managed superannuation fund). b I will cancel my existing insurance cover under my former fund within 60 days of receiving confirmation from FirstChoice Super products of my successful application. c I will not be transferring the cover under my former fund to any other division or section of the former fund or to any other fund, other than FirstChoice Super products. d I will not effect a continuation option, or subsequently reinstate cover within the former fund or any other division, section or category of the former fund, or within any fund or insurance policy where such reinstatement of cover is available to me. If you answered No to question 1, you will not be eligible for a rollover of insurance in FirstChoice Super products and will not be eligible to make a claim for this portion of cover. 2 Does the insurance cover have a superannuation account balance? If you answered to question 2, you need to transfer your entire balance, otherwise you will not be eligible for a rollover of insurance in FirstChoice Super products and will not be eligible to make a claim for this portion of cover. 16 FirstChoice Super products

19 PART B PERSONAL STATEMENT AND CONFIRMATION OF REQUIREMENTS (CONTINUED) 3 I confirm that my current level and type of cover under the former fund are as follows: Date cover started a Death cover $,, / / b TPD cover $,, / / c SCI cover $,, / / SCI waiting period, eg 30 days, 60 days, 90 days, 180 days Please note: SCI benefit cannot be greater than 85% (10% allowance for super) of your total income. SCI benefit period, eg two years, five years, to age 60, to age 65 I understand that my cover, once accepted, will be subject to the terms and conditions of FirstChoice Super products insurance arrangements. Please note: If you do not want to transfer the full amount of your cover, please advise the portion of cover you wish to transfer: Death cover $,, TPD cover $,, SCI cover $,, If you do not nominate any amounts, the full cover will be transferred. 4 Due to injury, illness or impairment: a b Are you unable to work 35 hours per week? Have you had your duties or workplace modified in the last two years and have you not resumed your pre modified duties? c Are you working in a role or occupation that has been designed or chosen to suit your needs? 5 Have you been paid, or are you eligible to be paid, or have you lodged or are you going to lodge a claim for terminal illness or disability, from a superannuation fund, life insurance company or any State or Federal Government body, such as Workers Compensation, Social Security, Veterans Affairs or a motor accident scheme? 6 In the last 12 months, have you been advised to commence or increase any treatment or medication for any ongoing or new medical condition (except for cold and flu and/or oral contraceptives)? If you answered to any of the questions 4 through to 6, you will not be eligible for a rollover of insurance in FirstChoice Super products. 7 Are you currently in the process of applying for insurance cover through Colonial First State or CommInsure or have you had any application previously declined? 8 Is your cover under the former fund subject to any premium loadings and/or exclusions, including but not limited to pre-existing condition exclusions, or restrictions in regard to medical or other conditions? If please provide details of the premium loadings, exclusions or restrictions, including a copy of the advice you received from the insurer or former fund advising you of the acceptance of your cover subject to these additional terms. No No PART C DUTY OF DISCLOSURE Acknowledgement I acknowledge that: if I do not fully complete, sign and date this application, I will not be eligible to roll over my existing cover to FirstChoice Super products, and if the insurer accepts my application, my existing amount of cover as at the rollover date under my former fund will be replaced by an equivalent amount of fixed cover, and if the insurer has accepted my application, my cover will commence in FirstChoice Super products on the date this application is completed subject to cancellation of my existing cover as outlined in Part B, and FirstChoice Super products and the insurer may undertake appropriate enquiry and investigation to verify the answers I have provided, and FirstChoice Super products and the insurer may investigate whether any restrictions that may have applied within the terms of the policy document were applicable to the type and/or level of cover stated on the up-to-date statement from the former fund, and I agree to provide FirstChoice Super products or the insurer with access to the health evidence I provided my former fund and its insurer in my application for cover, and any nondisclosure to a former fund or insurer may be acted upon by FirstChoice Super products or the insurer, and should it become apparent to FirstChoice Super products or the insurer that I have not undertaken the requirements that I confirmed in Part B above, then any insured benefit that may be payable to me or my estate or my beneficiaries from FirstChoice Super products may be reduced by the insured amount paid or payable from my former fund, an associated section or division of the former fund, or other fund, or any policy issued under any option I exercised, as a consequence of my failure to abide by these conditions; this reduction in benefit will, however, be limited to the extent that my benefit from FirstChoice Super products is no less than I would have been eligible to receive under the terms of the policy between FirstChoice Super products and the insurer had I not applied for a transfer of cover, and I understand that my cover, if accepted, will be subject to the terms and conditions and premiums of FirstChoice Super products insurance arrangements, as described in the current PDS, and I have received and read the current PDS explaining the terms and conditions and premiums that will apply to me under the FirstChoice Super products insurance arrangements. Insurance 17

20 PART C DUTY OF DISCLOSURE (continued) Your duty of disclosure You have a duty under the Insurance Contracts Act 1984 to disclose to the insurer every matter that you know, or could reasonably be expected to know, that is relevant to the questions contained in Parts A and B above that may impact the insurer s decision whether to accept the risk of the insurance and, if so, on what terms. This duty of disclosure applies before you enter into, extend, vary or reinstate a contract of life insurance with an insurer. Your duty, however, does not require disclosure of a matter: that diminishes the risk to be undertaken by the insurer that is of common knowledge that your insurer knows or, in the ordinary course of its business, ought to know as to which compliance with your duty is waived by the insurer, or unrelated to the questions contained in the personal statement. Signature of the person to be insured Non-disclosure If you fail to comply with your duty of disclosure and the insurer would not have covered you on any terms if the failure had not occurred, the insurer may void the cover within three years of issuing it. If your non-disclosure is fraudulent, the insurer may void your cover at any time. An insurer who is entitled to void your cover may, within three years of issuing it, elect not to void it but to reduce the sum that you have been insured for in accordance with a formula that takes into account the premium that would have been payable if you had disclosed all relevant matters to the insurer. Incomplete answers may delay the assessment of this application. Investments in FirstChoice Super products are issued from the Colonial First State FirstChoice Superannuation Trust ABN by Colonial First State Investments Limited ABN AFS Licence (Colonial First State). Print name Date signed / / Please send the completed form to: Colonial First State Reply Paid 27, Sydney NSW 2001 adviser use only Are you submitting any life insurance applications for this customer through CommInsure? Product name (eg Total Care Plan) Proposal/Policy number Should a blood test or a medical examination be required, please indicate whether you would like us to organise for a nurse to visit your client: Adviser name Dealer/Adviser stamp (please use black ink only) Contact number Dealer ID Adviser ID An address listed here may be used for adviser correspondence relating to the assessment of this application. 18 FirstChoice Super products

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