Accidental Death. Insurance Policy. Alliance Group Credit Union (the Credit Union)

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1 Accidental Death Insurance Policy Alliance Group Credit Union (the Credit Union)

2 Policy Schedule This summary repeats the information you disclosed to us in your application for Accidental Death Cover and contains the Monthly Premium details. Please ensure that ALL the details are correct. If they are not please advise us immediately on POLICY NUMBER: PERIOD OF COVER: [x] (renewable in accordance with the Policy terms) LIFE INSURED: [Full Name] CU Member Number [Access Database] POLICY OWNER: Policy Details: [Full Name] Commencement Date: [x] [Address 1] Accidental Death Benefit [$XXX] [Suburb] Monthly Premium: [$XXX.XX] [City] [Postcode] Our Rating Disclosure: Credit Union Insurance Limited has a BB+ (Stable) insurer financial strength rating given by Fitch Ratings. Fitch Ratings Long-Term International Insurer Financial Strength Rating Scale: AAA: Exceptionally strong AA: Very strong A: Strong BBB: Good BB: Moderately weak B: Weak CCC: Very weak CC: Extremely weak C: Distressed Notes: + or - may be appended to a rating to indicate the relative position of a credit within the rating category. Such suffixes are not added to ratings in the AAA category or to ratings below the B category. Introduction General Information This booklet contains the terms and conditions that apply to Your Accidental Death Policy and explains what You are covered for. This booklet includes Your Policy Schedule which shows details of Your insurance cover and premiums payable. This Policy is underwritten by Credit Union Insurance Limited, a subsidiary of the New Zealand Association of Credit Unions. Credit Union Insurance Limited trades under the name Co-op Insurance NZ. Credit Union Insurance Limited is hereafter referred to in this booklet as Co-op Insurance NZ. Free Look Period You have a 30 day Free Look Period from the date You receive this Policy to make sure that the Policy meets your requirements and if you have any questions or want further information do not hesitate to contact Credit Union Insurance. This Policy will be considered to have been received by You on the 3 rd day after posting. If you decide that You do not wish to continue with the Policy you must notify Co-op Insurance NZ within the 30 day Free Look Period. Any premiums that You have paid will be refunded and Co-op Insurance NZ will confirm in writing to You that the Policy has been cancelled.

3 Accidental Death Benefit If the Life Insured dies, and the death is a direct result of an Accident and occurs within 365 days of the Accident, Co-op Insurance NZ will pay the Policy Owner, or the Policy Owner s estate the Accidental Death Benefit as specified in the Policy Schedule. The Accidental Death Benefit cannot exceed NZ$100,000. The death of the Life Insured as a direct result of an Accident (and the Accident itself) must occur while the Policy is in force. Monthly Premiums The Monthly Premium payable is shown on the Policy Schedule. Co-op Insurance NZ may revise the Monthly Premium at any time if a change to the level of cover is agreed by us, or if we alter the table of Monthly Premium rates, applicable discounts or adjustment factors applying to policies of this type. We will give you 90 days notice in writing of any change to the amount of Your Monthly Premium, posted to Your last known address. This notice will be considered to have been received by You on the 3rd day after posting. In the event Co-op Insurance NZ varies this Policy, no individual policy can be singled out and treated less favourably than other Accidental Death Policies covering people with the same characteristics as the Life Insured. Travel or residence outside New Zealand No cover is available under this policy if the Life Insured either resides outside of New Zealand, or travels outside New Zealand, for a continuous period of 3 months or longer (unless agreed otherwise by in writing) and the Accident, Injury or death occurs during that period. Exclusions Co-op Insurance NZ will not pay a claim if the Accident causing the Life Insured s death was caused or contributed to by any of the following: Any illness, disease, naturally occurring condition, degenerative process, or symptom of any of these that the Life Insured has, or has had regardless of whether or not the Life Insured was aware of it. Any Injury that the Life Insured had, or had the indications of, before the Accident. Any surgical procedure unless the procedure was a necessity following an Injury. The Life Insured taking drugs or narcotics unless professionally administered by a doctor or unless professionally prescribed by and taken in accordance with the directions of a doctor or unless purchased at a pharmacy. A deliberate act by the Life Insured causing Injury to themselves, whether they are sane or insane. The Life Insured participating in a criminal or illegal act. The Life Insured participating in, or practising for, as a professional, any race, sport or activity of any kind. A Life Insured is deemed to be a professional if they have received, within the previous 2 years, any type of reward or remuneration for such participation or practice. The Life Insured participating in, or preparing for, scuba diving, parachuting, sky diving, bungy jumping, hang gliding, mountaineering, or rock climbing. The Life Insured flying on a non-scheduled flight or piloting any aircraft. The Life Insured having a breath or blood alcohol level in excess of the legal limits prescribed in New Zealand legislation at the time of the Accident or at the time of the claim. The Life Insured serving in the armed forces of any country or organisation. Any war-like activities (whether war is declared or not). The Life Insured cannot be covered under more than one Accidental Death Policy issued by Co-op Insurance NZ. General Conditions Policy Document and Alterations This Policy constitutes the entire contract between Co-op Insurance NZ and You and any alteration shall be in the form of an endorsement, signed by an authorised official representing Co-op Insurance NZ. Co-op Insurance NZ may alter any of the terms and conditions of the Policy by giving You 90 days notice in writing, posted to Your last known address. This notice will be considered to have been received by You on the 3rd day after posting. Provision of Information You shall provide to Co-op Insurance NZ all information regarding the Life Insured as it requires and which it considers relevant to the determination of the Accidental Death Benefit and premiums under this Policy. Surrender Value This Policy has no cash value if it is surrendered by You or cancelled. There will be no refund of premiums unless You cancelled the Policy within the 30 day Free Look Period. Assignment You cannot assign or have charged or mortgaged to any person, this Policy, or the Accidental Death Benefit under this Policy.

4 Domicile This Policy is issued in New Zealand. The laws of New Zealand apply to it. All amounts stated in the Policy Schedule are in New Zealand dollars. All premiums and the Accidental Death Benefit are inclusive of GST at the rate prescribed by law. Fraud Any misrepresentation, misstatement, or concealment by You or the Life Insured affecting this insurance or in connection with the making of any claim, gives Co-op Insurance NZ the right to refuse payment of any claim made by You. Disputes If You have a complaint, in the first instance You should contact Co-op Insurance NZ to discuss it. This will initiate the Co-op Insurance NZ internal complaints resolution process. Co-op Insurance NZ is a member of Financial Services Complaints Limited which is a free, independent service which can help settle any unresolved disputes you may have. Any dispute or action relating to this Policy will be determined in accordance with New Zealand law. When the Protection Starts and Ends The protection provided by this policy for a Life Insured starts on the Commencement Date shown on your Policy Schedule. All protection provided by this Policy for a Life Insured will end on (and the Policy will no longer be in force on) the earliest of the following: The death of the Life Insured; or When the Life Insured reaches the age of 86 years; or When the Policy is cancelled by You; or A Monthly Premium remains unpaid for 30 days, in which case cover will end on the date the last premium was paid up to; or 90 days after Co-op Insurance NZ provides You with written notice of its intention to cancel the Policy; or The Policy Anniversary Date; or The end of the term of this Policy, subject to any renewal by You. The term of the Policy is one month from the Commencement Date. The term of the Policy will automatically extend for further periods of one month from the end of the previous term until the Policy Anniversary Date upon payment of each Monthly Premium by You. With Our agreement, You may take out a new Policy at the Policy Anniversary Date on the same terms as this Policy, in which case we will send You a new booklet and Policy Schedule containing the terms and conditions that apply to Your new policy. Restarting the Protection If the protection ends because of cancellation or lapsing through non-payment of premiums You can apply to us to restart the protection. You must apply within 12 months of your Policy ending. Co-op Insurance NZ will advise You of the conditions for restarting the protection and will tell You in writing if and when it is restarted. Policy Age Limits The Life Insured must be aged between 16 and 79 years old at the Commencement Date. Protection ends when the Life Insured reaches the age of 86 years (if not before, see When the Protection Starts and Ends above). Making a claim To make a claim, contact Co-op Insurance NZ on: Telephone: ; or or Mail: Co-op Insurance NZ, P O Box 9582, Newmarket, Auckland We will tell You what evidence we require. The Policy Owner or the Life Insured s estate is responsible for the cost of providing this evidence. Co-op Insurance NZ will not make any payments until: we have received properly completed claim form(s), and acceptable evidence of the Life Insured s identity and satisfactory proof of the age of the Life Insured at the date of death; and we are satisfied that the claim is not excluded by any Policy terms or conditions; and we have received the information necessary for our assessment of the claim. If Co-op Insurance NZ finds the date of birth of the Life Insured is incorrect, then Co-op Insurance NZ can adjust the Accidental Death Benefit to the amount that it would have paid had it known the correct date of birth. No claims will be paid for events that occur after the protection ends.

5 Definitions Accident means an event not intended by a Life Insured, which causes Injury to that Life Insured. Accidental Death Benefit means the accidental death benefit amount shown in the Policy Schedule. Commencement Date means the commencement date shown in the Policy Schedule. Free Look Period means 30 days from the time You receive this Policy during which time you can cancel the Policy and have all premiums paid refunded. Injury means an injury sustained by the Life Insured which: is caused solely and directly by violent, accidental, external and visible means; and does not include sickness or disease of any naturally occurring condition or degenerative process; and is not intentionally self-inflicted; and is sustained after the Commencement Date. Life Insured means the Life Insured named in the Policy Schedule. Policy means the terms and conditions applying to this Insurance, as described in this booklet (including Your Policy Schedule). Policy Anniversary Date means the date that is 12 months after the Commencement Date. Policy Schedule means the most recent schedule issued by Co-op Insurance NZ and sent to your last notified postal address. Us/We/Our means Co-op Insurance NZ (the trading name for Credit Union Insurance Limited) You/Your means the Policy Owner as named in the Policy Schedule

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