Chinese Medicine & Acupuncture Society of Australia Ltd CMASA Membership Application Form [2014]

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Chinese Medicine & Acupuncture Society of Australia Ltd CMASA Membership Application Form [2014]"

Transcription

1 Chinese Medicine & Acupuncture Society of Australia Ltd CMASA Membership Application Form [2014] Personal Details: Title Dr/Mr/Mrs/Ms/Miss Date of Birth DD/MM/YYYY First Name Family Name 中 文 姓 : 名 : Home address Suburb State Postcode Postal Address To be used for all mail correspondence: State Postcode Phone (day) (0_) Mobile Fax ( ) Private Insurance Provider numbers [if available] Modalities Provider number Since year HCF Acu/ChM # Rem # Bupa Acu/ChM # Rem # Medibank Acu # Chm # Rem # others CMASA Membership application Form P1/6

2 Other professional Association Membership: (if applicable) Association name Membership number Education Qualifications and Professional Details Name of University / College **Qualifications Obtained (PhD/ Master / Bachelor) Graduation year Accreditation Certificate ( Vetassess /NOOSR) ( Overseas qualifications) **Please attached A4 separate sheet for more education qualification documents. **Certified true copies (by the Justice of the Peace) of all relevant documents stated above must be attached. Professional Experience (number of years and specialised field) Other Studies CMASA Membership application Form P2/6

3 Accredited for: Acupuncture? Yes No Chinese Herbal Medicine? Yes No TCM Remedial (Chinese) Massage? Yes No Remedial Massage (Australia)? Yes No Start date Expiry date First Aid Certificate Professional Indemnity Insurance PII Insurance Company Professional Indemnity Amount $ Public Liability Amount $ Please attach a copy of your current 1/ First Aid Certificate and 2/ PII Certificate of Currency. CMBA registration number CMR Private/Business Practice Details: Clinic or Trading name ABN ( if available ) Details Clinic [ 1 ] Address Postcode Phone (0 ) mobile Clinic [ 2 ] Address Postcode Phone (0 ) mobile Clinic [ 3 ] Address Postcode Phone (0 ) mobile CMASA Membership application Form P3/6

4 Declaration: Please answer the following questions: 1) Are you the subject of any unresolved complaint, or investigation by a professional association or registration/recognition/professional services review body? Please tick : Yes No your signature: 2) Have you ever been the subject of an adverse finding by such an association or body? Please tick : Yes No your signature: 3) I am a citizen / holding a legitimate permit to work in Australia? Please tick : Yes No your signature: Please provide details on separate sheet if your answer is yes. I certify that the information I have supplied is correct and up-to-date to the best of my knowledge. I understand that as a member of CMASA, I will abide by the constitutions of CMASA and abide the CMASA Code of Ethics and Standards of Practice in order to continue to be a member. I agree that the above information can be provided to any Private Health Insurance company by CMASA for the purpose of registering me to be a recognised provider with that particular Private Health Insurance Company. I agree to adhere and abide to all the CMASA membership requirements. Signature Date Please return completed Membership Application Form with and Application fees (cheque payable to CMASA) to: Please attach a recent (6 months) Passport size photo here. CMASA Membership Committee 1 st Floor, 23 John Street, Cabramatta, NSW 2166 Phone (02) Fax (02) CMASA Membership application Form P4/6

5 OFFICE USE ONLY Applicant full name: Contact: Phone ( 0 ) Mobile Allocate membership number CMASA Application Fee Cheque $100 Receive date Bank in date Notify date by by by Checked by Membership Committee signature Approve Reject date Comment name signature Approve Comment Reject date name Private Insurance Assessment date. Signature Name. AUSTRALIAN REGIONAL HEALTH GROUP LTD A.C.A. Health Benefits Fund Cessnock District Health Benefits Fund CUA Health Limited Defence Health GMHBA GMF Health Health Care Insurance Limited Health Partners HIF WA Latrobe Health Services (Federation Health) Mildura District Hospital Fund Navy Health Fund Onemedifund People care Health Insurance Police Health Fund Queensland Country Health Ltd Reserve Bank Health Society Phoenix Health fund check Railway&Transport Health Fund ltd. St.Luke s Health Teachers Federation Health Teachers Union Health Transport Health United Ancient Order of Druids Friendly Society Westfund CBHS HBF Grant United Australian Unity Manchester Unity AHM NRMA Medibank Private HCF Bupa Group check CMASA Membership application Form P5/6 Information Sheet [for your keeping]

6 Application Fee Application forms should be accompanied by a non-refundable application Administration Fee of $100 per applicant for Full, Associate and Provisional members. There will be no application fees for applicant with CMBA approved programs or with existing Health fund provider numbers. Application Fee of $10 for Student member (no annul membership fee for student member) standard Early birds Late fees Reinstatement The standard annual membership fee $160 $140 $180 $220 The two-year membership fee $288 $ The three-year membership fee $408 $ o Standard means payment in full before/on 31 January 2013 o Early birds mean payment before /on 31 December o Late means payment after 31 January 2014 o Reinstatement means payment after 1 March 2014 New members will receive a welcome letter with details of membership 4-6 weeks upon receipt of application forms.. Annual membership fee should be sent soonest after receipt of welcome letter to activate membership benefits. Membership fee can be paid via 1/ Direct Debit or bank application fee cheque Commonwealth Bank Account name : CMASA BSB: Ac Please state membership number and surname in description box. 2/ Cheque payable to CMASA to be sent to address CMASA Membership Committee 1 st Floor, 23 John Street, Cabramatta, NSW 2166 Please state your full English name and membership number in the description column or at the back of you cheque. Then notify us by Please provide following information for us to send you a receipt: full name, CMASA number (if available), postal address and evidence of payment if pay by direct debit. CPD Record A completed CPD record, with minimum 20 points, should be sent by 31 December. CPD record can be sent preferably via or fax (02) ; or mail to 1F 23 John Street Cabramatta 2166 NSW If you need further assistance, please feel free to contact CMASA Secretary at CMASA Membership application Form P6/6

Private Practice Insurers

Private Practice Insurers Private Practice Insurers 1. Have you worked in private practice during the past 12 months? (If response is no, you have completed the survey. Thank you for your participation) Percent Yes 97.1% 67 No

More information

Information about Health Funds

Information about Health Funds Information about Health Funds association of massage therapists CONTENTS Getting started with health fund provider numbers 3 Keeping track of your provider numbers 4 Health fund provider arrangements

More information

Combined limit for Physiotherapy, Chiropractic,

Combined limit for Physiotherapy, Chiropractic, Health Funds- Cover, Couples Classification Type of cover Test results Budget Couple Bupa Australia Pty Ltd Bronze - Couple Monthly premium before rebate ($) $45.60 State QLD Policy Type Features (%) 12

More information

Health Funds- Extras Cover, Singles From Choice Online Health Insurance Comparisons Review (30 Jun 2014)

Health Funds- Extras Cover, Singles From Choice Online Health Insurance Comparisons Review (30 Jun 2014) Health Funds- Cover, Singles Classification Budget Budget Type of cover Single Single Test results Bupa Australia Pty Ltd Bupa Australia Pty Ltd Bronze - Single Active Saver Monthly premium before $22.80

More information

Combined limit for Physiotherapy, Chiropractic,

Combined limit for Physiotherapy, Chiropractic, Funds- Cover, Families From Choice Online Insurance Comparisons Review (30 Jun 2014) Classification Type of cover Budget Family Bupa Australia Pty Ltd Bronze - Family Monthly premium before rebate ($)

More information

Proposal to recognise Remedial Massage Therapy

Proposal to recognise Remedial Massage Therapy Proposal to recognise Remedial Massage Therapy May 2007 The Association of Massage Therapists Ltd PO Box 792 Newtown NSW 2042 T: 02 9517 9925 F: 02 9517 9952 massage@amt-ltd.org.au www.amt-ltd.org.au Preamble

More information

Health Fund Provider Information Eligibility

Health Fund Provider Information Eligibility Australian Association of Massage Therapists Membership Kit Health Fund Provider Information Eligibility On joining AAMT you signed an agreement to keep your First Aid and Insurance up-todate, earn CPE

More information

HEALTH FUND CHANGES REGISTER

HEALTH FUND CHANGES REGISTER CHANGES REGISTER PERSONAL INFORMATION Member Name: Your Signature: CHANGE OF NAME Former Name: CHANGE OF EMAIL Former email: CHANGE OF MOBILE NUMBER Former Mobile Number: CHANGE OF HOME LANDLINE Former

More information

AMT Practitioner Membership Application Form

AMT Practitioner Membership Application Form Association of Massage Therapists Ltd PO Box 826 Broadway NSW 2007 T: 02 9211 2441 F: 02 9211 2281 info@amt.org.au www.amt.org.au ABN 32 001 859 285 AMT Practitioner Membership Application Form APPLICATION

More information

Private Health Insurance and Hearing Health

Private Health Insurance and Hearing Health Private Health Insurance and Hearing Health Audiological Benefits provided by the Private Health Funds in Australia 2013 edition Private Health Insurance and Hearing Health Audiological Benefits provided

More information

PRIVATE HEALTH INSURANCE AND HEARING HEALTH AUDIOLOGICAL BENEFITS PROVIDED BY THE PRIVATE HEALTH FUNDS IN AUSTRALIA

PRIVATE HEALTH INSURANCE AND HEARING HEALTH AUDIOLOGICAL BENEFITS PROVIDED BY THE PRIVATE HEALTH FUNDS IN AUSTRALIA PRIVATE HEALTH INSURANCE AND HEARING HEALTH AUDIOLOGICAL BENEFITS PROVIDED BY THE PRIVATE HEALTH FUNDS IN AUSTRALIA & 2015 EDITION Private Health Insurance and Hearing Health Audiological Benefits provided

More information

SASS FORM 405 APPLICATION FOR BENEFIT PAYMENT UPON (OR DEFERRAL) How to apply. Use this form... Do not use this form. Notes for applicants

SASS FORM 405 APPLICATION FOR BENEFIT PAYMENT UPON (OR DEFERRAL) How to apply. Use this form... Do not use this form. Notes for applicants SASS FORM 405 APPLICATION FOR BENEFIT PAYMENT UPON (OR DEFERRAL) THE DEATH OF A SASS OF CONTRIBUTORY BENEFITS ON OR RETRENCHMENT DEFERRED BENEFIT MEMBER Please print clearly in black ink. Use this form...

More information

Frequently Asked Questions

Frequently Asked Questions Frequently Asked Questions I am a member of ATMS. Why can t I be a provider for all health funds? All health funds have set criteria that all associations must abide by. This criterion is sometimes higher

More information

Hearing Test by a Registered Practitioner will pay 50 %, unlimited. Complete Ancillary. Ancillary Lite

Hearing Test by a Registered Practitioner will pay 50 %, unlimited. Complete Ancillary. Ancillary Lite at February 2014. Information is to be used as a guideline Locked Bag 2014 ACA Health Benefits Fund ACA Wahroonga NSW 2076 http://www.acahealth.com.au Australia Complete Ancillary Ancillary Lite Hearing

More information

REQUEST FOR WITHDRAWAL

REQUEST FOR WITHDRAWAL REQUEST FOR WITHDRAWAL If you need help For assistance call NGS Super Customer Service Team on 1300 133 177. Step 1. Complete your personal details Please print in black or blue pen, in uppercase, one

More information

Early release of super on compassionate grounds How to make a claim

Early release of super on compassionate grounds How to make a claim Early release of super on compassionate grounds How to make a claim Please note if you have ceased work due to sickness or injury, call us on 13 11 84 before proceeding. Am I eligible to make a claim?

More information

Restricted (Corporate Lawyer)

Restricted (Corporate Lawyer) 2015-2016 Application for a Restricted (Corporate Lawyer) Local Practising Certificate and Membership te: Legal practitioner employed by an entity (excluding a government agency or law practice) and limited

More information

Recognition of Prior Learning Application Diploma of Financial Services (Financial Planning) FNS50804 and RG 146

Recognition of Prior Learning Application Diploma of Financial Services (Financial Planning) FNS50804 and RG 146 Recognition of Prior Learning Application Diploma of Financial Services (Financial Planning) FNS50804 and RG 146 1. WHAT IS RECOGNITION OF PRIOR LEARNING (RPL)? RPL stands for recognition of prior learning.

More information

State of the Health Funds Report

State of the Health Funds Report State of the Health Funds Report 2 010 An independent assessment of the comparative performance and service delivery of Australia s private health insurance providers. Private Health Insurance Ombudsman

More information

HEALTHPOINT USER GUIDE.

HEALTHPOINT USER GUIDE. HEALTHPOINT USER GUIDE. CONTENTS 1. Getting Started with HealthPoint 5 1.1 Introduction 5 1.2 Everyday Procedures 5 1.3 HealthPoint Maintenance 5 2. Contact Details 6 2.1 HealthPoint Helpdesk Contacts

More information

STATE OF THE HEALTH FUNDS REPORT 2011

STATE OF THE HEALTH FUNDS REPORT 2011 State of the Health Funds Report 2011 Private Health Insurance Ombudsman STATE OF THE HEALTH FUNDS REPORT 2011 Relating to the financial year 2010-11 Report required by 238-5(c) of the Private Health Insurance

More information

AHSA PARTICIPATING Funds CONTACT LIST. Access. Gap. Cover. Simplifying Gap Cover for you and your patients

AHSA PARTICIPATING Funds CONTACT LIST. Access. Gap. Cover. Simplifying Gap Cover for you and your patients AHSA PARTICIPATING Funds CONTACT LIST Access Gap Cover Simplifying Gap Cover for you and your patients Australian Health Management 2 Queensland Country Health Ltd 4 Formerly Trading as: (Previously called

More information

State of the Health Funds Report

State of the Health Funds Report State of the Health Funds Report 2013 This work is copyright. Apart from any use permitted under the Copyright Act 1968, no part may be reproduced without written permission. Requests concerning reproduction

More information

Application for Accreditation by Testing

Application for Accreditation by Testing Application for Accreditation by Testing OFFICE USE ONLY AUS NZ OS Please use blue or black ball point pen to complete this form. Please print in BLOCK LETTERS. NAATI Number: (if known) Part 1 Please provide

More information

ARCHITECTS BOARD OF WESTERN AUSTRALIA

ARCHITECTS BOARD OF WESTERN AUSTRALIA ARCHITECTS BOARD OF WESTERN AUSTRALIA Application for Registration in Western Australia under Mutual Recognition Form 02 3 August 2015 Use of this Form This form is to be used by people wishing to apply

More information

CONTENTS. Australian Health Management 2 Queensland Country Health Ltd 4 Formerly Trading as:

CONTENTS. Australian Health Management 2 Queensland Country Health Ltd 4 Formerly Trading as: Australian Health Management 2 Queensland Country Health Ltd 4 Formerly Trading as: (Previously called MIM Employees Health Society) Australian Country Health Government Employees Health Fund rt health

More information

Student Enrolment Form

Student Enrolment Form Name of Course: Date: Student Enrolment Form Course No: Health Schools Australia P.O. Box 815 Helensvale Qld. 4212 Ph: (07) 55308899 Fax: (07) 55308877 Electives Chosen: Please attach two recent passport

More information

Public Health Act 1997 Form CT5

Public Health Act 1997 Form CT5 Approved form AF2002-245 Approved by the General Manager of the Health Protection Service on 6.12.2002 under the Public Health Act 1997, s137a Public Health Act 1997 Form CT5 (see s56m) Australian Capital

More information

Form 18 Application for a Queensland electrical contractor licence

Form 18 Application for a Queensland electrical contractor licence Electrical Safety Office Form 18 Application for a Queensland electrical contractor licence V17.06-2014 Electrical Safety Act 2002 INSTRUCTIONS: Read the guidelines when completing this application form.

More information

PRIVATE HEALTH INSURANCE OMBUDSMAN. State of the Health Funds Report

PRIVATE HEALTH INSURANCE OMBUDSMAN. State of the Health Funds Report 2014 PRIVATE HEALTH INSURANCE OMBUDSMAN State of the Health Funds Report Private Health Insurance Ombudsman State of the Health Funds Report 2014 Relating to the financial year 2013 14. Report required

More information

Alternative/Complementary Medicines and Therapies Insurance Proposal Form

Alternative/Complementary Medicines and Therapies Insurance Proposal Form Alternative/Complementary Medicines and Therapies Insurance Proposal Form We will confirm the premium and period of insurance once we have reviewed your application 1. PERIOD OF INSURANCE The intial policy

More information

Request to Increase Insurance Life Event

Request to Increase Insurance Life Event Request to Increase Insurance Life Event Accumulation Scheme (Division 5) members only Use this form to apply to increase your insurance cover when a specific life event has occurred. As an accumulation

More information

Membership Application OTASA Scheme of Co-operation

Membership Application OTASA Scheme of Co-operation MEDICAL PROTECTION SOCIETY PROFESSIONAL SUPPORT AND EXPERT ADVICE Membership Application OTASA Scheme of Co-operation 012 362 5457 Please complete all parts of this form in BLACK INK and BLOCK CAPITALS

More information

Superannuation and Deferred Annuity Redemption / transfer form

Superannuation and Deferred Annuity Redemption / transfer form Superannuation and Deferred Annuity Redemption / transfer form This form is to be used when redeeming your superannuation benefit from the Zurich Deferred Annuity or from the Zurich Master Superannuation

More information

PERSONAL DETAILS BASIS FOR APPLICATION

PERSONAL DETAILS BASIS FOR APPLICATION APPLICATION FM (for transitional arrangements only) APS SUPERVISED PRACTICE ASSOCIATE MEMBER - MASTERS ROUTE APS COLLEGES PERSONAL DETAILS Dr c Mr c Mrs c Ms c Miss c Other c Family name: Former name (if

More information

Application for a real estate salesperson registration certificate

Application for a real estate salesperson registration certificate New registration application Form 3 1 Notes Application for a real estate salesperson registration certificate Property Occupations Act 2014 This form is effective from 1 December 2014 ABN: 13 846 673

More information

Agents financial administration Form 4

Agents financial administration Form 4 Agents financial administration Form 4 Collection agent application for authority to open a trust account Agents Financial Administration Act 2014 Debt Collectors (Field Agents and Collection Agents) Act

More information

ACCREDITATION as an AACBT COGNITIVE and BEHAVIOURAL THERAPIST RENEWAL

ACCREDITATION as an AACBT COGNITIVE and BEHAVIOURAL THERAPIST RENEWAL ACCREDITATION as an AACBT COGNITIVE and BEHAVIOURAL THERAPIST RENEWAL General Information Accredited AACBT Cognitive and/or Behavioural Therapists must meet the AACBT s criteria for professional registration,

More information

Complete this form to withdraw part or all of your benefit as a lump sum, roll over to another GESB account and/or to another complying super fund.

Complete this form to withdraw part or all of your benefit as a lump sum, roll over to another GESB account and/or to another complying super fund. Benefit access Gesb Super and West State Super SUP E R ANNUATION Complete this form to withdraw part or all of your benefit as a lump sum, roll over to another GESB account and/or to another complying

More information

Mutual Recognition. Who can apply? Build better.

Mutual Recognition. Who can apply? Build better. Build better. Mutual Recognition Mutual Recognition is a process whereby an individual who holds a licence in one state, territory or New Zealand is entitled to be licensed in another state, territory

More information

APPLICATION FORM ASSESSMENT OF PSYCHOLOGY QUALIFICATIONS

APPLICATION FORM ASSESSMENT OF PSYCHOLOGY QUALIFICATIONS APPLICATION FORM ASSESSMENT OF PSYCHOLOGY QUALIFICATIONS REGISTRATION, EMPLOYMENT OR UNIVERSITY ENTRY This form is for the assessment of psychology qualifications for registration, employment or entry

More information

Fair Trading will aim to make a decision on your application within 6 weeks after receiving all relevant information from you and other agencies.

Fair Trading will aim to make a decision on your application within 6 weeks after receiving all relevant information from you and other agencies. Application No. OFFICE USE ONLY Form PL-21 ABN 81 913 830 179 Property, Stock and Business Agents Act 2002 Application for a CERTIFICATE OF REGISTRATION FEE: $129.00 - applicable from 1 July 2015 to 30

More information

The Airlie Share Fund Application Form for Individual / Joint Investor / Sole Trader / Individual Trustee

The Airlie Share Fund Application Form for Individual / Joint Investor / Sole Trader / Individual Trustee The Airlie Share Fund Application Form for Individual / Joint Investor / Sole Trader / Individual Trustee This Application Form forms part of the Information Memorandum for The Airlie Share Fund (Fund).

More information

CANSTAR S GUIDE TO. Choosing health insurance

CANSTAR S GUIDE TO. Choosing health insurance CANSTAR S GUIDE TO Choosing health insurance AUSTRALIA HAS A TERRIFIC UNIVERSAL HEALTH CARE SYSTEM, CALLED MEDICARE. THIS SYSTEM ENSURES THAT ALL AUSTRALIANS HAVE ACCESS TO FREE HOSPITAL TREATMENT IN THE

More information

APPLICATION for ACCREDITATION as an AACBT Ltd. COGNITIVE and BEHAVIOURAL THERAPIST

APPLICATION for ACCREDITATION as an AACBT Ltd. COGNITIVE and BEHAVIOURAL THERAPIST APPLICATION for ACCREDITATION as an AACBT Ltd. COGNITIVE and BEHAVIOURAL THERAPIST General Information Members of AACBT Ltd. who meet the AACBT s national standards for CBT training and practice can apply

More information

Application Form. for corporate membership. The Guild of Letting & Management

Application Form. for corporate membership. The Guild of Letting & Management Application Form for corporate membership The Guild of Letting & Management Guild of Letting & Management application for corporate membership tes for Applicants The Membership Department aim to process

More information

Information for temporary residents departing Australia

Information for temporary residents departing Australia Information for temporary residents departing Australia MLC Superannuation What is a Departing Australia Superannuation Payment? The Departing Australia Superannuation Payment (DASP) is the payment of

More information

Private Health Insurance Ombudsman State of the Health Funds Report 2012 Relating to the financial year 2011 12

Private Health Insurance Ombudsman State of the Health Funds Report 2012 Relating to the financial year 2011 12 Private Health Insurance Ombudsman State of the Health Funds Report 2012 Relating to the financial year 2011 12 Report published by the Private Health Insurance Ombudsman This work is copyright. Apart

More information

Private Health Insurance Ombudsman STATE OF THE HEALTH FUNDS REPORT

Private Health Insurance Ombudsman STATE OF THE HEALTH FUNDS REPORT Private Health Insurance Ombudsman STATE OF THE HEALTH FUNDS REPORT 2005 (Relating to the financial year 2004-05) Report required by paragraph 82ZRC (ba) of the National Health Act 1953 i THE STATE OF

More information

ANZ HealthPoint. Merchant Operating Guide

ANZ HealthPoint. Merchant Operating Guide 1 ANZ HealthPoint Merchant Operating Guide Contents 2 1. Getting Started with ANZ HealthPoint 5 1.1 Introduction 5 1.2 ANZ HealthPoint Maintenance 5 1.3 Everyday Procedures 5 2. Contact Details 6 2.1 ANZ

More information

Application for benefit payment or transfer

Application for benefit payment or transfer Application for benefit payment or transfer Use this form if you want to cash in your benefit or transfer all or part of your super balance to another super fund. This form should not be used by temporary

More information

LAST NAME GIVEN NAME(S) DATE CEASED / / LAST NAME GIVEN NAME(S) DATE CEASED / /

LAST NAME GIVEN NAME(S) DATE CEASED / / LAST NAME GIVEN NAME(S) DATE CEASED / / Application by an INDIVIDUAL FOR A NSW SECURITY LICENCE under the Mutual Recognition Act 1992 and/or Trans-Tasman Mutual Recognition Act 1997 OFFICE USE ONLY Application No: - Receipt No: - Trim No: To

More information

ACCOUNT APPLICATION FORM & IDENTIFICATION FORM

ACCOUNT APPLICATION FORM & IDENTIFICATION FORM ACCOUNT APPLICATION FORM & IDENTIFICATION FORM This form may be used to apply for a new Account or to verify the identity of an existing Provisional account holder. INSTRUCTIONS Please complete Section

More information

DIPLOMA OF AUSTRALIAN TAXATION LAW

DIPLOMA OF AUSTRALIAN TAXATION LAW Tax Practitioners Board Approved course in Australian Taxation Law DIPLOMA OF AUSTRALIAN TAXATION LAW The Tax Education Program Tax Practitioners Board Approved Course taxinstitute.com.au STUDYING AT THE

More information

HEALTH INSURANCE REPORT 2015 STATE OF THE OMBUDSMAN HEALTH FUNDS RELATING TO THE FINANCIAL YEAR 2014-15

HEALTH INSURANCE REPORT 2015 STATE OF THE OMBUDSMAN HEALTH FUNDS RELATING TO THE FINANCIAL YEAR 2014-15 PRIVATE HEALTH INSURANCE OMBUDSMAN STATE OF THE HEALTH FUNDS REPORT 2015 RELATING TO THE FINANCIAL YEAR 2014-15 Report required by 20D (c) of the Commonwealth Ombudsman Act 1976 This work is copyright.

More information

Suncorp Bank HealthPoint User Guide

Suncorp Bank HealthPoint User Guide Suncorp Bank HealthPoint User Guide Contents 1 Getting Started with Suncorp Bank HealthPoint 1.1 Introduction...4 1.2 Everyday Procedures...4 1.3 HealthPoint Set-up...4 2 Contact Details...5 2.1 Suncorp

More information

Health Fund ECLIPSE Functionality August 2011. Functionality

Health Fund ECLIPSE Functionality August 2011. Functionality Functionality OPV EPV IMC ERA Medical OEC IHC ERA Hospital OPV PVF PVM PVM AG SC PC MB TW ECF OEC AG SC PC MB ACA Health Benefits Fund x x x x x x x Australian Health Management Group x x x x x x x Australian

More information

Renewal of registration Building surveying contractor (individual) Form 63

Renewal of registration Building surveying contractor (individual) Form 63 Government of Western Australia Department of Commerce Renewal of registration Building surveying contractor (individual) Form 63 Use of this form This form is to be used by building surveyors who are

More information

CONCEPT DOES NOT REQUIRE AN UP FRONT DEPOSIT (Except for Standard IVF/ICSI/FET where out of pocket costs must be paid in advance)

CONCEPT DOES NOT REQUIRE AN UP FRONT DEPOSIT (Except for Standard IVF/ICSI/FET where out of pocket costs must be paid in advance) Concept Fertility Centre Explanation of Fees and Request Forms (Effective 1st January 2015) INTRODUCTION All Assisted Reproductive Technology Services such as; Artificial Insemination (AI) In Vitro Fertilisation

More information

Please only use this form when you wish to open a Suncorp Share Trade Account: in your name, or in joint names

Please only use this form when you wish to open a Suncorp Share Trade Account: in your name, or in joint names Stockbroking INDIVIDUAL/JOINT ACCOUNT application form Please only use this form when you wish to open a Suncorp Share Trade Account: in your name, or in joint names In order to process your application

More information

Form 11 Application for electrical work licence/permit (other than apprentice)

Form 11 Application for electrical work licence/permit (other than apprentice) Electrical Safety Office Form 11 Application for electrical work licence/permit (other than apprentice) V15.06-2014 Electrical Safety Act 2002 If you are applying for an additional electrical work training

More information

Professional Indemnity Insurance Application Form for Eligible Midwives

Professional Indemnity Insurance Application Form for Eligible Midwives Professional Indemnity Insurance Application Form for Eligible Midwives This Form will be used by MIGA to consider your application for Professional Indemnity Insurance with MIGA and for your automatic

More information

Application for Admission to QUT as an International Student in a Research Program

Application for Admission to QUT as an International Student in a Research Program Queensland University of Technology Student Business Services Victoria Park Road Kelvin Grove Qld 4059 Australia Phone 07 3138 2000 Fax +61 7 3138 3529 www.international.qut.edu.au CRICOS No. 00213J ABN

More information

APPLICATION FORM ASSESSMENT OF PSYCHOLOGY QUALIFICATIONS

APPLICATION FORM ASSESSMENT OF PSYCHOLOGY QUALIFICATIONS APPLICATION FORM ASSESSMENT OF PSYCHOLOGY QUALIFICATIONS MIGRATION This form is for the assessment of psychology qualifications for the purposes of migration to Australia under the General Skilled Migration

More information

How to complete the AML/CTF Investor Identification Information Form

How to complete the AML/CTF Investor Identification Information Form How to complete the AMLCTF Investor Identification Information Form The Australian government has introduced legislation called the Anti-Money Laundering and Counter Terrorism Financing Act 2006 which

More information

Pension Application Form

Pension Application Form PITCHER RETIREMENT PRP PLAN Pension Application Form Member Details Mr Mrs Miss Ms Other First given name Middle names Family name Date of Birth / / Residential address Suburb/town State Postcode Daytime

More information

Application Form for Millinium's Wholesale Fixed Income Fund Individual(s) / Sole Trader (Resident/Non Resident)

Application Form for Millinium's Wholesale Fixed Income Fund Individual(s) / Sole Trader (Resident/Non Resident) Before you sign this application form, we wish to give you a Information Memorandum ("IM") which is a summary of important information relating to Millinium's Wholesale Fixed Income Fund ("Fund"). The

More information

CPA AUSTRALIA APPLICATION TO TRADE WITH A NON-MEMBER / APPLICATION FOR AN AUTHORITY TO TRADE AS CERTIFIED PRACTISING ACCOUNTANTS INTRODUCTION

CPA AUSTRALIA APPLICATION TO TRADE WITH A NON-MEMBER / APPLICATION FOR AN AUTHORITY TO TRADE AS CERTIFIED PRACTISING ACCOUNTANTS INTRODUCTION CPA AUSTRALIA APPLICATION TO TRADE WITH A NON-MEMBER / APPLICATION FOR AN AUTHORITY TO TRADE AS CERTIFIED PRACTISING ACCOUNTANTS INTRODUCTION PLEASE READ THESE INSTRUCTIONS CAREFULLY This is an interactive

More information

HONG KONG ASSOCIATION OF INTERACTIVE MARKETING (HKAIM) 香 港 互 動 市 務 商 會 Certified Digital Marketer (CDM) Application Form

HONG KONG ASSOCIATION OF INTERACTIVE MARKETING (HKAIM) 香 港 互 動 市 務 商 會 Certified Digital Marketer (CDM) Application Form HONG KONG ASSOCIATION OF INTERACTIVE MARKETING (HKAIM) 香 港 互 動 市 務 商 會 Certified Digital Marketer (CDM) Application Form For office use only: Application for Registration Application Ref: Verified: Approved

More information

Application for an Electrical Contractor s Licence

Application for an Electrical Contractor s Licence Application for an Electrical Contractor s Licence 303 Sevenoaks Street (entrance Grose Ave) Cannington WA 6107 Postal Address: Locked Bag 14 Cloisters Square WA 6850 Telephone: (08) 6251 2000 Email enquires

More information

Professional Indemnity Insurance for the Planning Profession

Professional Indemnity Insurance for the Planning Profession Professional Indemnity Insurance for the Planning Profession Important Notices Claims Made Policy This Proposal is for a policy issued by the insurer on a claims made and notified basis. This means that

More information

Stockbroking. INDIVIDUAL/JOINT ACCOUNT application form. Please only use this form to open a trading account: in your name, or in joint names

Stockbroking. INDIVIDUAL/JOINT ACCOUNT application form. Please only use this form to open a trading account: in your name, or in joint names Stockbroking INDIVIDUAL/JOINT ACCOUNT application form Please only use this form to open a trading account: in your name, or in joint names In order to process your application we will need: your completed

More information

Application for accreditation as a recognised BAS agent association

Application for accreditation as a recognised BAS agent association Application for accreditation as a recognised BAS agent association Completing this application form You will need to have read the information sheet Recognised BAS agent association before completing

More information

ANZ Superannuation Savings Account Withdrawal Form

ANZ Superannuation Savings Account Withdrawal Form Withdrawal Fm 1 July 2015 Customer Services Phone 13 38 63 Fax 02 9234 6668 Email customer@onepath.com.au Website anz.com This fm is f existing invests in ANZ Superannuation Savings Account only. INSTRUCTIONS

More information

Advance Retirement Suite Super Early Release Financial Hardship Application

Advance Retirement Suite Super Early Release Financial Hardship Application Advance Retirement Suite Super Early Release Financial Hardship Application Trustee: BT Funds Management Ltd (BTFM) ABN 63 002 916 458 AFSL 233724 GUIDE TO COMPLETING THIS FORM > > Use this form if you

More information

Withdraw super from your Rollover Account

Withdraw super from your Rollover Account Withdraw super from your Rollover Account This is the form you should use when you withdraw your superannuation from the APSS Rollover. The minimum amount you may withdraw from your APSS Rollover Account

More information

Identity Verification Form Australian Superannuation Funds and Trusts

Identity Verification Form Australian Superannuation Funds and Trusts Identity Verification Form Australian Superannuation Funds and Trusts To comply with our obligations under the Anti-Money Laundering (AML) and Counter Terrorism Financing (CTF), all new investors are required

More information

The Australian Health Insurance Appointed Actuary

The Australian Health Insurance Appointed Actuary The Australian Health Insurance Appointed Actuary Andrew Gale Chief Actuary Medibank Private Overview Private Health Insurance in Australia The developing actuarial role in Health Insurance The Health

More information

2015 Application Form Honours degree of the Bachelor of Health Science 3971

2015 Application Form Honours degree of the Bachelor of Health Science 3971 2015 Application Form Honours degree of the Bachelor of Health Science 3971 Submission deadline: 31 October, 2014 Entry requirements To be considered for entry to the Honours Degree of the Bachelor of

More information

Application for Admission to QUT as an International Student in a Research Program

Application for Admission to QUT as an International Student in a Research Program Queensland University of Technology Student Business Services Victoria Park Road Kelvin Grove Q 4059 Phone +61 7 3138 2000 Fax +61 7 3138 3529 www.international.qut.edu.au CRICOS No. 00213J ABN: 83 791

More information

Claim Form TRAVEL INSURANCE

Claim Form TRAVEL INSURANCE ACCIDENT & HEALTH INTERNATIONAL Claim Form TRAVEL INSURANCE Sydney Level 4, 33 York Street Sydney NSW 2000 GPO Box 4213, Sydney, NSW, 2001 T: +61 2 9251 8700 F: +61 2 9252 4385 ABN: 26 053 335 952 AFS

More information

Application for increases without further medical evidence

Application for increases without further medical evidence MLC Insurance MLC Insurance (Super) Application for increases without further medical evidence Policy number(s) Name of Life Insured This form allows the Income Protection, Life Cover, Total and Permanent

More information

1. NAME OF FIRM TO BE INSURED 2. ADDRESS OF FIRM 3. THE FIRM. (please include full names of all entities to be insured) Phone ( ) Email

1. NAME OF FIRM TO BE INSURED 2. ADDRESS OF FIRM 3. THE FIRM. (please include full names of all entities to be insured) Phone ( ) Email SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au MISCELLANEOUS PROFESSIONAL INDEMNITY

More information

APPLICATION FOR NEW CERTIFICATE OF COMPETENCE

APPLICATION FOR NEW CERTIFICATE OF COMPETENCE APPLICATION FOR NEW CERTIFICATE OF COMPETENCE This is an application form for a certificate of competence under the Health and Safety in Employment (Mining Operations and Quarrying Operations) Regulations

More information

International Application

International Application International Application Personal Details Family Name: Given Names: Date of Birth (DDMMYYYY): Gender: Male Female Place of Birth: Nationality: Language(s) spoken at home: Passport Number: Passport Expiry

More information

WHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME

WHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME WHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME Issued 1 November 2014 Please use this form to transfer your whole superannuation balance to a KiwiSaver scheme. Transferring only part of your superannuation

More information

Registration Building surveying contractor (company) Form 38

Registration Building surveying contractor (company) Form 38 Government of Western Australia Department of Commerce Registration Building surveying contractor (company) Form 38 Use of this form This form is to be used by unincorporated bodies, body corporate and

More information

4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director

4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au ACCOUNTANTS PROFESSIONAL INDEMNITY

More information

General Health Fund Terms and Conditions of Provider Status

General Health Fund Terms and Conditions of Provider Status Provider status with any health fund is not the right of the practitioner. It is a privilege for the skilled health care professional. As such, health care professionals need to ensure that they understand

More information

Wholesale Australian Property Fund and Australian Property Fund Application form

Wholesale Australian Property Fund and Australian Property Fund Application form Office use only Wholesale Australian Property Fund and Australian Property Fund Application form Issuer and responsible entity: National Mutual Funds Management Ltd ABN 32 006 787 720, AFSL 234652 National

More information

Withdrawal Flexi Pension

Withdrawal Flexi Pension Fact sheet and form Withdrawal Flexi Pension You can make a full or partial lump sum withdrawal from your Flexi Pension account at any time. What this fact sheet covers This fact sheet explains the rules

More information

AAMT Massage Therapist Proposal Form Combined Malpractice, Public and Products Liability Insurance effective 30 September 2015

AAMT Massage Therapist Proposal Form Combined Malpractice, Public and Products Liability Insurance effective 30 September 2015 Page 1 of 5 AAMT Proposal Form Combined Malpractice, Public and Products Liability Insurance effective 30 September 2015 Please complete and return this proposal form via post, email or fax using the contact

More information

Recognition criteria for complementary & alternative therapies

Recognition criteria for complementary & alternative therapies Recognition criteria for complementary & alternative therapies This document outlines the essential educational requirements and additional recognition criteria necessary for providers to become a recognised

More information

Fixed insurance cover

Fixed insurance cover Fact sheet and form Fixed insurance cover When it comes to insurance cover, one size doesn t necessarily fit all. That s why you have the ability to convert your Death and Total & Permanent Disablement

More information

New Graduates of Canadian or U.S. Accredited Programs

New Graduates of Canadian or U.S. Accredited Programs New Graduates of Canadian or U.S. Accredited Programs In order to apply for registration with the Saskatchewan Association of and Audiologists (SASLPA), a new graduate is required to submit the following:

More information

APPLICATION FOR REGISTRATION AS A BUILDING PRACTITIONER CERTIFYING ENGINEER - INDIVIDUAL

APPLICATION FOR REGISTRATION AS A BUILDING PRACTITIONER CERTIFYING ENGINEER - INDIVIDUAL NORTHERN TERRITORY BUILDING PRACTITIONERS BOARD APPLICATION FOR REGISTRATION AS A BUILDING PRACTITIONER CERTIFYING ENGINEER - INDIVIDUAL SECTION 1 PERSONAL DETAILS FAMILY NAME (Surname) GIVEN NAME (First

More information

Application for a Practising Certificate & Membership of The Law Society of New South Wales

Application for a Practising Certificate & Membership of The Law Society of New South Wales Legal Profession Act 2004 ACN 000 000 699 ABN 98 696 304 966 Application for a Practising Certificate & Membership of The Law Society of New South Wales To be completed by an Australian lawyer who does

More information

Immunisation for registered nurses Course outline

Immunisation for registered nurses Course outline Immunisation for registered nurses Course outline IMMUNISATION FOR REGISTERED NURSES Course Dates 1. 03 Feb 24 25 Apr 24 2. 03 Mar 24 23 May 24 3. 07 Apr 24 27 Jun 24 4. 05 May 24 25 Jul 24 5. 02 Jun 24

More information

Life Events/Salary Increase cover

Life Events/Salary Increase cover Fact sheet and form Life Events/Salary Increase cover What this fact sheet covers This fact sheet provides information about Life Events insurance cover and Salary Increase cover available through our

More information

Completion Certificate Application Form (New Zealand Degree Holders Only) [Effective 15 March 2016]

Completion Certificate Application Form (New Zealand Degree Holders Only) [Effective 15 March 2016] PERSONAL DETAILS [Please Print] Full Legal Name* Completion Certificate Application Form (New Zealand Degree Holders Only) [Effective 15 March 2016] Surname First Name Middle Name(s) Name Used Surname

More information