LifeProtect Insurance

Transcription

1 LifeProtect Insurance Dated: 1 April 2013 Issued by Avanteos Investments Limited (Trustee) ABN AFS Licence Locked Bag 3460 GPO Melbourne VIC 3001 Phone

2 Contents 1 Your insurance options 2 Applying for insurance cover 4 The costs associated with insurance 6 Life and total and permanent disablement insurance 8 Income protection insurance 10 Making a claim 11 Leaving the superannuation service 12 Glossary 14 Schedule of medical condition definitions 16 Contact information Important information This brochure is issued by Avanteos Investments Limited (ABN AFSL ), the Trustee. The Trustee holds a Responsible Superannuation Entity (RSE) Licence issued by the Australian Prudential Regulation Authority (APRA) (RSE Licence L ). The Trustee is the trustee of The Avanteos Superannuation Trust (AST) (ABN ), the Symetry Personal Retirement Fund (SPRF) (ABN ), the Ultimate Superannuation Fund (USF) (ABN ), and the encircle Superannuation Fund (ESF) (ABN ) (superannuation services). All insured benefits are underwritten by The Colonial Mutual Life Assurance Society Limited (CMLA) (ABN , AFSL ) trading as CommInsure (Insurer). The Trustee and CMLA are wholly owned subsidiaries of the Commonwealth Bank of Australia ABN AFSL The information in this brochure is general information only and does not take into account your individual objectives, financial situation or needs. You should read this brochure, assess whether the product is appropriate for you and speak to your financial adviser before making a decision. The Trustee has arranged for members of the superannuation services to receive Life, Life and Total and Permanent Disablement (TPD) and Income Protection insurance in accordance with the terms and conditions of the underlying policy documents ( Policy, or the Policies ). You can obtain a copy of the Policies, free of charge, by contacting your financial adviser or the Trustee. While every effort has been made to ensure the information in this brochure is accurate, the Trust Deeds and the Policies form the basis of the LifeProtect insurance offering and should be read carefully. The examples and illustrations provided in this brochure are only intended to demonstrate how certain insurance benefits are calculated. All insurance benefits will be determined in accordance with the Trust Deed, the relevant Superannuation Law and the relevant conditions contained in the Policies. In this brochure, you and your refers to the life insured.

3 Your insurance options The Trustee and the Insurer have developed a range of insurance options for you as a member of a superannuation service including life cover, life and total and permanent disablement (TPD) cover and income protection cover. This brochure may help you understand the insurance cover available to you as a member of a superannuation service, including details of the associated terms and conditions. You should read the Product Disclosure Statement (PDS) of your superannuation service in conjunction with this brochure as it contains important information regarding insured benefits. LifeProtect benefits and features Summary Cover Life Life & TPD Income Protection Pays a lump sum benefit in the event of your death or terminal illness. Pays a lump sum benefit if you become totally and permanently disabled or in the event of your death or terminal illness. Pays a monthly benefit for the period of disablement or until the benefit period has expired if you become totally or partially disabled. Features Life Life & TPD Income Protection Insurance benefits Terminal illness benefits Buy back benefit Future insurability up to 25% of your cover or $100,000, whichever is the lesser when you get married or become a parent up to 25% of your cover or $100,000, whichever is the lesser when you get married or become a parent Indexation to the Consumer Price Index (CPI) Interim accident cover up to $1 million up to $1 million up to $15,000 per month for two years Eligibility Entry age Expiry age Cover limits Minimum cover $ nil $ nil $ nil Maximum cover maximum. Terminal illness limited to $2 million $3 million. Terminal illness limited to $2 million $30,000 per month (2 year benefit period) or $25,000 for benefit periods of greater than 2 years 1

4 Applying for insurance cover How do I apply for insurance cover? New members of a superannuation service are able to apply for insurance cover up to a maximum of $400,000 for life or life and TPD cover within 30 days of joining a superannuation service by completing the LifeProtect application form A1, which contains a limited number of eligibility questions. If completed online, your insurance application will be assessed by the Insurer immediately after you answer the required questions to determine if you are eligible for cover. If you are a member of a superannuation service and are within the eligible age range and a permanent resident of Australia, you can apply for insurance cover by contacting your financial adviser. Depending on the level of cover you wish to apply for you may be asked to provide health evidence, and financial evidence if the cover you have elected is above a certain limit. You can apply for life or life and TPD cover up to $800,000 and/or income protection cover up to $6,000 per month by completing the LifeProtect and Income Protection application form A2, which contains limited eligibility questions. For life or life and TPD cover above $800,000 and/or income protection above $6,000, a Full Personal Statement is required. The Insurer may require you to provide further evidence to assess your application, depending on answers you provided on the personal statements. Your financial adviser will be able to assist you in determining the level and type of cover you require. Application forms are available through your financial adviser or the Trustee. What is my duty of disclosure? Before you enter into or become insured under a contract of life insurance with an insurer, 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, is relevant to the Insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before you extend, vary or reinstate life insurance. 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, or as to which compliance with your duty is waived by the Insurer. n-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. Am I eligible for interim accident cover? While the Insurer is assessing your application, you will receive interim accident cover for the amount of cover you have applied for, up to the maximum levels specified below. For example, if you have applied for life and TPD cover of $800,000 and income protection cover of $6,000 per month and you become disabled as a result of an accident while the Insurer assesses your application, you will be eligible to claim for these amounts. The insurance benefit is only payable if you die, or become disabled within 120 days of being involved in an accident. The maximum amount of benefit that will be paid as a result of an accident is $1,000,000 for life or TPD and $15,000 per month for two years for income protection. Interim accident cover will continue until the earliest of: (a) the date you withdraw your application for insurance cover or additional insurance cover (b) the date the Insurer accepts your application for cover or additional insurance cover on standard or special terms (c) the date the Insurer rejects your application for insurance cover or additional insurance cover (d) the date a benefit becomes payable (e) the date the Insurer cancels the interim accident cover, or (f) 120 days from the date you applied for insurance cover or additional insurance cover. Interim accident cover is subject to the same exclusions, limitations, restrictions and claim procedures that apply under the policy. If you are entitled to make a claim your application for cover is automatically cancelled. In addition, the Insurer will require payment of the premium for the period from the date you applied for cover to the date of the accident. For income protection cover, monthly benefits are subject to the waiting period you have applied for and will continue until the earliest of the date: (a) you are no longer totally disabled (b) the benefits have been paid for two years (c) the first day of the month in which you reach age 65 (d) you die. 2

5 When does my cover start? You will be advised of the start date for your cover in writing. Your cover commences when the Insurer has accepted your application and you have commenced your membership of the superannuation service. You must be in active employment when your cover starts, or you will receive limited cover until you are in active employment for 2 consecutive months. How do I transfer my existing insurance cover? If you have existing insurance cover outside the superannuation service in another superannuation fund or a retail policy, you can apply to transfer your cover over to LifeProtect. For more information, please refer to the Insurance Transfer Form available from your financial adviser. Can I keep my insurance cover if travelling overseas? Once you have cover you will generally continue to be covered if you leave Australia. The maximum time that the Insurer will pay an income protection benefit while a person is outside Australia is 6 months. If you place a claim for an insurance benefit while overseas, you may need to return to Australia at your own expense in order to complete medical assessment requirements for the Insurer. How do I increase my cover? You may apply to increase your insurance cover at any time, up to the maximum amounts offered, by contacting your financial adviser. You may need to provide health and financial evidence to the Insurer. How do I reduce or cancel my cover? You can cancel or reduce your insurance cover at any time by advising the Insurer or Trustee in writing. Your insurance premiums will reduce or cease from the end of the month prior to the Insurer or Trustee receiving your request. If you cancel your cover, you will continue to be covered for 60 days after your cover is cancelled at no cost for life cover, and for TPD provided that you are eligible to exercise a continuation option. See page 11 for further information. When does cover cease? Your cover ends in the superannuation service on the earliest of the following: the date a benefit is paid for you that reduces your insured cover to nil the date a terminal illness or TPD benefit becomes payable for you (income protection cover only) the first day of the month you reach the cover expiry age, which is 75 for life cover, 70 for TPD cover, and 65 for income protection cover the end of the month prior to you providing written confirmation that you wish to cancel your insured cover, or on another date the Insurer agrees in writing. You will continue to be covered for 60 days after your cover is cancelled at no cost for life cover, and for TPD provided that you are eligible to exercise a continuation option. See page 11 for further information. 2 months after you have insufficient funds in your superannuation cash account to pay your insurance premiums if you commence active duty in any armed forces, other than the Australian Armed Forces Reserves the date of your death when you leave the superannuation service. Increasing your cover when you get married or become a parent If you get married, or become a parent you can apply to increase your life and/or TPD cover. The maximum increase permitted without providing any medical evidence is the lesser of $100,000 or 25% of your current sum insured. The following conditions apply: if both life and TPD insurance is held then you must increase both in proportion you apply and provide satisfactory evidence within 60 days of the event occurring you can only exercise this option once in a 12 month period, and any increase in your cover is subject to the same exclusions and special conditions as your previous level of cover. 3

6 The costs associated with insurance Your insurance premium consists of: insurance premium insurance charge, if applicable for insurance arrangements entered into prior to 1 July 2013, adviser commission. How do I calculate my premium? The cost of your insurance cover will be advised to you in writing at the time your cover is accepted. It will depend on the type and level of your cover, your age, gender, whether you smoke and what occupational rating you have been accepted for. The occupational loading is dependent on your type of occupation classification. Occupation classifications Professional White Collar / Clerical n Manual Blue Light Manual Heavy Manual You hold a tertiary qualification or are a member of an institute or registered Government body and earn more than $80,000 per annum. You may also be in a management role. You work entirely in an office environment (or at least 80%) with no manual work. Your roles are primarily non-manual, but may involve some light manual work from time to time. You are a skilled or semi-skilled trades person who does a moderate amount of manual work. You are an unskilled manual worker, or a skilled heavy manual worker. The premium rates and occupational loadings applicable are available from your financial adviser. The following examples use sample rates for the purposes of illustration and are not representative of what premiums may be applicable to you. Example 1 Sue is turning 50 on her next birthday and has an annual income of $42,000. She is a non-smoker and works as a clerical employee, meaning an occupation loading of 100% applies. Life and TPD sum insured = $400,000 Insurance cost Sum insured $100,000 x premium rate x occupational loading applicable. $400,000 $100,000 x $10.34 x 100% = $41.36 per month. Therefore the annual premium is $ Example 2 Kate is turning 35 on her next birthday and has an income of $180,000. She has selected a 90 day waiting period and an age 65 benefit period. She is a smoker, and as a professional employee an occupation loading of 90% applies. Income protection sum insured $180,000 x 75% = $135,000 $135, months = $11,250 monthly benefit Insurance cost Insured monthly benefit $1,000 x premium rate applicable x occupational loading $11,250 $1,000 x $9.44 x 90% = $95.58 per month. Therefore the annual premium is $1,

7 How do I pay premiums? Premiums are automatically deducted on a monthly basis from the available cash balance in your superannuation account and paid in arrears to the Insurer. You need to ensure there is sufficient money available in your account to meet your premium payment. What happens if there are insufficient funds to pay the premium? Where you have insufficient funds to meet your premium payments, you will be notified in writing and requested to top up your superannuation account. If a premium payment cannot be made to the Insurer due to insufficient funds for two consecutive months, the Insurer will write to advise you that your insurance cover has lapsed. To reinstate your insurance cover you will need to reapply. Are there any other costs associated with my insurance? The Trustee may be paid an Insurance Charge to cover administration costs associated with maintaining your insurance cover through the superannuation service. For arrangements entered into prior to 1 July 2013, your insurance premium may also include adviser commissions as agreed between you and your financial adviser. Please refer to the PDS for important information regarding the fees and premiums associated with your insurance cover. Will the premium amount change? Premiums generally increase as your age increases. Premiums are calculated based on your age at your next birthday on your cover start date and will be updated each year on 1 July. If you have selected to have your cover amount increased in line with the Consumer Price Index (CPI), your sum insured will be amended to take advantage of this increase, up to a maximum increase of 7.5% on 1 July each year. A minimum increase of 3% per annum will be applied each year. This will also have an effect on your premium amount. You will be advised of your new premium amount and the amount of cover you have on your superannuation service annual benefit statement. Your premium will also change where you apply to increase or reduce your cover. Premiums may also change where you advise the Insurer that you have changed your details, including (but not limited to) changes to your occupation, smoking status, benefit period and waiting period. The Trustee or Insurer may also change the premium rates and we will notify you as required under Superannuation Law if this occurs. 5

8 Life and total and permanent disablement insurance What types of life cover are available? Life insurance You can apply for life only cover if you are less than 69 years old and an Australian permanent resident. You can apply for life and TPD insurance cover if you are less than 64 years old and an Australian permanent resident. LifeProtect offers the following life cover types: Life cover a lump sum benefit payable in the event of terminal illness or the death of the member Life and TPD cover a lump sum benefit payable in the event of death, terminal illness or total and permanent disablement of the member. If you have life cover, a terminal illness benefit is payable if you are certified by a medical practitioner specialising in that illness, that the illness will (despite reasonable medical treatment) lead to your death within 12 months of the date of the certification. It is paid from your life cover up to a maximum of $2 million. You can also elect at the time of applying for cover to have your cover amount increased, effective 1 July each year, in line with the Consumer Price Index (CPI), at a minimum of 3% and up to a maximum of 7.5% pa. If you do not make this election when you first have the opportunity, you may have to provide health evidence at a later date. Total and Permanent Disability insurance TPD cover is not available as a stand-alone insurance option and must be combined with life cover. The TPD sum insured cannot exceed the amount of life cover or $3 million, whichever is lesser. Own Occupation TPD cover If you are a professional worker, you can apply for an own occupation TPD cover. This means any claims for TPD cover will be assessed against your capacity to resume your own occupation (not any occupation you might be qualified for). For more details, refer to page 7. TPD Definitions LifeProtect contains a number of TPD definitions to enable easier access to your benefit in the event of a claim. Each of these definitions is described below. You will be considered totally and permanently disabled if: Definition 1 You suffer, as a result of sickness or injury: the complete and irrecoverable loss of use of two limbs the complete and irrecoverable loss of use of one foot and one hand blindness in both eyes, whether aided or unaided, or the complete and irrecoverable loss of use of one limb and blindness in one eye, whether aided or unaided where: limb means the whole hand below the wrist or whole foot below the ankle, and blindness means the permanent loss of sight to the extent that visual acuity is 6/60 or less, or to the extent that the visual field is reduced to 20 degrees or less of arc. Definition 2 You suffer as a result of sickness or injury, the total inability to perform any two of the following activities of daily living or all of the defined home duties without the physical assistance of another person. Activities of daily living dressing the ability to put on and take off clothing toileting the ability to use the toilet, including getting on and off mobility the ability to get in and out of bed and on and off a chair continence the ability to control bowel and bladder function feeding the ability to get food from a plate into the mouth bathing the ability to wash yourself either in the bath or shower or by sponge bath without the standby assistance of another person and you are permanently and irreversibly unable to do so for life. Or Defined Home Duties cleaning the usual place of dwelling purchasing household food and items used for cleaning preparing meals for the household performing for the household laundry services such as washing or ironing. 6

9 Definition 3 You were, on the date of disablement, aged 65 years or less and: (i) are absent from all work as a result of suffering from one or more of the following conditions: cardiomyopathy, primary pulmonary hypertension, major head trauma, motor neurone disease, multiple sclerosis, muscular dystrophy, paraplegia, quadriplegia, hemiplegia, diplegia, tetraplegia, dementia and Alzheimer s disease, Parkinson s disease, blindness, loss of speech, loss of hearing, chronic lung disease or severe rheumatoid arthritis (each as defined in the Schedule of Medical Conditions on page 14) (ii) the Insurer considers, on the basis of medical and other evidence satisfactory to them, you are unlikely ever to be able to engage in any occupation, whether or not for reward, and (iii) you are likely to be so disabled for life 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. Or (iv) absent from all work as a result of suffering one or more of the following conditions: cardiomyopathy, primary pulmonary hypertension, major head trauma, motor neurone disease, multiple sclerosis, muscular dystrophy, paraplegia, quadriplegia, hemiplegia, diplegia, tetraplegia, dementia and Alzheimer s disease, Parkinson s disease, blindness, loss of speech, loss of hearing, chronic lung disease or severe rheumatoid arthritis (each as defined in the Schedule of Medical Conditions on page 14) (v) the Insurer considers, on the basis of medical and other evidence satisfactory to them, you are unlikely ever to be able to engage in your own occupation, whether or not for reward, and (vi) you are likely to be so disabled for life where occupation means gainful occupation that you were engaging in on a full time basis immediately prior to total and permanent disablement. Definition 4 If you were engaged in full time domestic duties or child rearing at the time of the sickness or injury, then you will only be considered totally and permanently disabled if: (i) through sickness or injury, you are unable to perform domestic duties or child rearing and have been confined to the home for a period of six consecutive months and you are under the regular treatment, and following the advice, of a medical practitioner, and continue to be so incapacitated to the extent that you are unable to engage in (whether or not for reward) any occupation for which you are reasonably suited by education, training or experience and are likely to be so disabled for life (ii) you have been unable to perform domestic duties or child rearing and you are confined to the home as a result of cardiomyopathy, primary pulmonary hypertension, major head trauma, motor neurone disease, multiple sclerosis, muscular dystrophy, paraplegia, quadriplegia, hemiplegia, diplegia, tetraplegia, dementia and Alzheimer s disease, Parkinson s disease, blindness, loss of speech, loss of hearing, chronic lung disease, or severe rheumatoid arthritis (each as defined in the Schedule of Medical Conditions on page 14) and you are under the regular treatment, and following the advice, of a medical practitioner, and you continue to be so incapacitated to the extent that you are unable to engage in (whether or not for reward) any occupation for which you are reasonably suited by education, training or experience and are likely to be so disabled for life. Definition 5 For TPD (any occupation): (i) you were, on the date of disablement, aged 65 years or less and employed, and (ii) as a result of illness or injury, have been absent from all work for six consecutive months from the date of disablement and the Insurer considers, on the basis of medical and other evidence satisfactory to them that you are unlikely ever to 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. or For TPD (own occupation): (i) you were, on the date of disablement, aged 65 years or less and employed, and (ii) as a result of illness or injury, have been absent from all work for six consecutive months from the date of disablement and the Insurer considers, on the basis of medical and other evidence satisfactory to them that you are unlikely ever to be able to engage in your own occupation, whether or not for reward where occupation means gainful occupation that you engage in on a full time basis immediately prior to total and permanent disablement. Despite the above, you will not be totally and permanently disabled under Definition 5 if: (i) at any time after you cease employment but prior to the date of disablement, you are not employed for a period of six or more consecutive months from the termination date of your last period of employment ( period of unemployment ), and (ii) you do not, after your most recent period of unemployment but prior to the date of disablement, return to active employment for 40 consecutive working days. 7

10 Income protection insurance What income protection cover is available? If you are a permanent full time employee, less than 65 years old, an Australian permanent resident and are working more than 15 hours per week you are eligible to apply for income protection cover within your superannuation service. The cover provided is an indemnity value policy which allows you to insure up to 75% of your pre disability income. This means you will receive a benefit based on your income at the time you are disabled (even if it has decreased since your cover commenced). You can also elect at the time of applying for cover to have your cover amount increased, effective 1 July each year, in line with the Consumer Price Index (CPI), at a minimum of 3% and up to a maximum of 7.5% pa. If you do not make this election when you first have the opportunity you may need to provide health evidence at a later date. What is the waiting period? The waiting period is the continuous period of time you have to be totally or partially disabled before you can qualify for a monthly benefit. The waiting period starts from the day a registered medical practitioner certifies that you are disabled. LifeProtect offers a choice of waiting periods: 30, 60 or 90 days. Premiums vary according to the waiting period you choose. te: You should notify the Trustee of your intention to claim as soon as possible, regardless of your waiting period. What is a benefit period? The benefit period is the length of time the income protection benefit will be paid for. The benefit will cease on the earlier of the date: you are no longer disabled the benefit payment period ends you turn age 65, or you die. You can choose from a benefit period of 2 years, or to age 65. When does an income protection benefit become payable? Income protection cover provides the following benefits and the events in which they are paid are detailed below: Total disability benefit Partial disability benefit Rehabilitation expense benefit Recurrent disability benefit. Total Disability Benefit The total disability benefit is paid if you are totally disabled for longer than your chosen waiting period. Insurance benefits can continue until the end of the benefit period, up to age 65, provided you continue to be totally disabled. The amount of total disability benefit you will receive is the monthly benefit (see Glossary on page 12) subject to a maximum of $30,000 per month for benefit period of 2 years, or $25,000 per month for benefit periods in excess of 2 years. Total disability means that because of sickness or injury, you are: unable to perform one or more of the income producing duties of your own occupation under the regular care of, and following the advice of, a registered medical practitioner satisfactory to the Insurer, and not working in any occupation, whether or not for reward. The total disability benefit the Insurer will pay is the monthly benefit subject to certain offsets. See both the Glossary on page 12 for an explanation of monthly benefit and Will the benefit payable be offset? on page 10. To illustrate, if you become entitled to the total disability benefit, are not subject to any offsets, and you have the following cover: Monthly benefit: $3,000 Waiting period: 90 days the Insurer will pay a benefit of $3,000 per month provided that you continue to be totally disabled, after you have waited 90 days (the waiting period). The period during which the benefit will be paid depends on the benefit payment period that applies to you. 8

11 Partial Disability Benefit A partial disability benefit is payable if you are partially disabled after the waiting period has ended. This benefit can continue until the end of the benefit period, provided you continue to be partially disabled, but not beyond age 65. You are partially disabled if, because of sickness or injury, you: have been totally disabled for at least 14 days are unable to work in your own occupation at full capacity immediately after you became totally disabled because of the sickness or injury that caused your total disability are working in your own occupation in a reduced capacity, or working in another occupation are earning a monthly income that is less than your pre disability income, and are under the regular care of, and following the advice of, a medical practitioner acceptable to the Insurer. If you are partially disabled, the monthly benefit will be reduced by the amount calculated with the formula below: Current income x monthly benefit Pre-disability income For example if you suffer a partial disability which results in your income decreasing from $4,000 to $2,000 per month and your monthly benefit is $3,000, the Insurer will calculate the partial disability benefit to which you may be entitled as follows: $3,000 ($2,000 $4,000 x $3,000) Partial disability benefit = $3,000 $1,500 = $1,500 per month. Rehabilitation Expense Benefit A rehabilitation expense benefit is payable in addition to the disability benefit if you are disabled and participate in a rehabilitation or vocational retraining program (that is approved by the Insurer before the expenses are incurred). The Insurer will reimburse the cost of the approved rehabilitation program (subject to a maximum of 24 times your monthly benefit). Approved rehabilitation programs exclude programs providing hospital treatment or ancillary health benefits (as defined in the National Health Act 1953) as those laws prevent the Insurer paying a benefit for these programs. Recurrent Disability Benefit If you are disabled again from the same or a related cause within six months of you last receiving a disability benefit, the waiting period will not apply. The recurrence of your disability will be treated as a continuation of the original claim. Are there any limitations and exclusions applicable to the income protection insurance? The Insurer will only pay benefits for one disability at a time. A benefit will not be paid if a sickness or injury is directly or indirectly caused by: intentional self-inflicted injury or infection, or attempted suicide whether or not you are sane at the time your service in the armed forces of any country war, or normal and uncomplicated pregnancy or childbirth including multiple pregnancy, caesarean birth, threatened miscarriage, participation in in-vitro fertilisation or other medically assisted fertilisation techniques and normal discomforts of pregnancy (such as morning sickness, backache, varicose veins, ankle swelling and bladder problems). What if I take a period of leave without pay? Cover will continue while you are on leave without pay from your employer, but your pre disability income will be affected. To illustrate, if you become entitled to the total disability benefit while you have been on leave without pay for 8 months and you have the following cover: Monthly benefit: $2,000 Waiting period: 90 days if your monthly income is $3,000, we will calculate your pre disability income as [(8 x $0) + (4 x $3,000)] = $12,000. This means your monthly benefit will be subject to a maximum of 75% of your pre-disability income of $1,000 per month, i.e. $750, which you will receive until the benefit period ends. 9

12 Making a claim How do I make a claim? You should notify the Trustee as soon as possible after you become aware of any claim or potential claim. Before a benefit is paid you must: provide the Insurer with satisfactory proof of age, if required complete any relevant claim forms and provide supporting evidence of the claim provide the Insurer with such medical, income or other evidence as it requires from time to time (at your expense) undergo any medical or other examination which the Insurer reasonably requires. The Insurer will pay medical fees but will not pay any other costs such as travel expenses, and in the case of income protection cover, comply with any medical treatment or rehabilitation program that is reasonable. What will occur if my claim is successful? Life and TPD Payments made as a result of death, TPD or terminal illness will be made to the Trustee. In distributing this money the Trustee will be guided by the relevant Superannuation Law and the Trust Deed, and in the event of a death benefit, any nomination of beneficiaries that you have made. Refer to the PDS for more information on benefit payments. If your life insurance amount exceeds $2 million and you are successful in lodging a claim for terminal illness, the excess life insurance amount will continue in the superannuation service. If your life insurance amount exceeds your TPD insurance amount and you are successful in lodging a claim for TPD, the excess life insurance amount will continue in the superannuation service. Life buy-back option Twelve months after the Trustee has been paid a TPD benefit for you, you may be able to take out a continuation option for life only cover. Please contact your financial adviser for more information. Will the benefit payable be offset? Your monthly benefit will be reduced if you receive other disability payments during the same period from: 1. any income (other than insurance benefits received under LifeProtect) or commutation of income, paid as a result of your sickness or injury, including: any sick leave entitlements any amounts payable under legislation, such as worker s compensation or motor accident compensation any insurance benefits payable under any other insurance policy that provides income benefits upon disability 2. any applicable social security payments 3. any income earned by personal exertion while disabled, but excluding any income earned from your employer 4. any income which, in the Insurer s opinion, you could reasonably be expected to earn in your occupation while disabled excluding any income actually earned from your employer. Any income described in paragraph 1, 2 or 3 which is in the form of a lump sum or is exchanged for a lump sum will have a monthly equivalent of 1/60th of the lump sum over a period of 60 months. Can the benefit be indexed? If the Insurer is paying a disability benefit and the benefit payment period exceeds 2 years, at the end of every consecutive 12 month period, the Insurer will increase your monthly benefit by the percentage increase of the CPI (Weighted Average of 8 Cities Combined Index) up to a maximum of 7.5%. The indexation of benefit payments is designed to help offset the impact of inflation. Will I pay premiums while in receipt of an income protection benefit? You are not required to pay income protection premiums while a total or partial disability benefit is being paid to you; but you must continue to pay premiums throughout the waiting period. You must also continue to pay premiums for any life or life and TPD cover you have while in receipt of an income protection benefit. Income Protection If you are successful in making an income protection claim, the insurance benefits start the day after the waiting period has ended. Benefit payments are payable monthly in arrears and are calculated for the part of the month they are payable. All initial certificates and evidence (including any medical evidence) required by the Insurer for the claim will be provided at your expense. Insurance benefits will be paid to you as an income payment. The Trustee will provide you with a group certificate, which you will need to include as income on your personal tax return. 10

13 Leaving the superannuation service Can I continue my insurance cover if I close my superannuation account? If you elect to leave the superannuation service, you have the option within 60 days of closing your superannuation account to apply for cover under a new individual policy with the Insurer. The following conditions apply: you must be less than 75 years of age for life cover, 64 years for TPD cover and 60 years for income protection cover when your cover ended under the Policies held with the Trustee of the superannuation service you were employed on a permanent basis for at least 15 hours per week when your cover ended under the Policies (for income protection cover only) when your cover ended under the Policies, no benefit was, or was about to be, payable under the Policies and no circumstances existed which, if the subject of a claim under the Policies, would have resulted in a benefit being payable to you under the Policies the premium payable for you was not overdue when your cover ended under the Policies any exclusions or special conditions applicable to your cover under the Policies will apply to the individual policy issued by the Insurer the Insurer receives the request for cover under the new individual policy and the correct premium for that cover within 60 days of your cover ending you do not join any armed forces (other than the Australian Armed Forces Reserve) before the date the individual policy is issued under the new individual policy you will receive benefits no greater than those provided under the Policies prior to closing your superannuation account (including the monthly benefit, waiting period, and benefit period for income protection cover) the terms and premium rates current for the individual policy at the time it is issued will apply the Policies with the Trustee of the superannuation service must be still in-force, and CommInsure s minimum policy issue requirements are met. Once you have exercised a continuation option, you will not be eligible for any future cover under the Policies unless the Insurer agrees in writing. 11

14 Glossary This section explains the key terms that have been bolded throughout this brochure. Please refer to the Policies for full definitions, terms and conditions. You should speak to your financial adviser if you are unsure of any of the definitions or what they mean for your insurance cover. Important terms used in the brochure Terms At work Active employment Employed Employee Full time basis Income producing duties Income Meaning You are at work if (i) you are actively performing all the duties and work hours of your own occupation free of any limitation due to sickness or injury and you are not entitled to or receiving income support benefits from any source including workers compensation benefits, statutory transport accident benefits and disability income benefits, or (ii) you are on employer approved leave (but not sick leave) and on your last working day met the requirements of (i). You are in active employment if you are: (a) employed (including being on fully paid leave caused by sickness or injury) to carry out identifiable duties where employed includes casual employment for more than 15 hours per week and self-employment, (b) actually performing those duties, and (c) in the Insurer s opinion, not restricted by sickness or injury from being capable of performing those duties on a full time basis and the duties of your own occupation on a full time basis (even if not working on a full time basis). Or (life and TPD only) (d) not employed for reasons other than sickness or injury, and in the Insurer s opinion you are not restricted by sickness or injury from being capable of performing the duties of your own occupation on a full time basis (even if you are not working on a full time basis). Means employment (including casual employment for more than 15 hours per week) or self-employment, for gain or reward, in any business, trade, profession, vocation, calling, occupation or employment. An employee includes a person who satisfies both of the following: (a) the person is an employee under the expanded meaning of that term in section 12(3) of the Superannuation Guarantee (Administration) Act 1992 (Cth) (the SG Act ), and (b) the person is a person for whom the employer is required to pay superannuation contributions to avoid or reduce the superannuation charge payable pursuant to the SG Act. In interpreting the conditions of this policy the employer is regarded as: the employer of, and being in an employer/employee relationship with the person. At least 30 hours per week. The duties of your own occupation (see page 13) immediately before you became totally disabled which generates 20% or more of your income. How you perform your own occupation will be taken into account when determining the income producing duties. 1. If you are employed on a casual basis, work as an independent contractor, or earn an income from a business you directly own part of or all of, income means the remuneration earned by you from all regular occupations. Where you directly own all or part of the business in which you perform a regular occupation, your income is the total amount earned by that business for the relevant period as a direct result of your personal exertion, less your share of business expenses, but before the deduction of income tax, for that business for the same period. 2. If you do not fall within paragraph 1, income means the regular annual remuneration expected to be earned by you from permanent employment in all regular occupations including: (a) the value of a fringe benefit which: (i) you receive from your employer by way of salary sacrifice, and (ii) you would benefit from for at least 6 months after the date on which the salary, which you sacrificed for the fringe benefit, would have first become payable by your employer, and (b) performance related annual bonuses and commissions (averaged over the lesser of the preceding 3 years and the period for which you have been in receipt of such bonuses or commissions). 12

15 Terms Limited cover Monthly benefit Own Occupation Superannuation service Pre-disability income Meaning You are covered only for death, terminal illness, and/or disability arising from: a sickness which first became apparent, or an injury which first occurred on or after the date you last commenced, recommenced or increased your cover in the superannuation service. The lesser of: 75% of income (refer page 12) divided by 12, or 75% of pre disability income (refer below) subject to a maximum of $30,000 per month if your benefit period is 2 years, or $25,000 if your benefit period is until you reach age 65. The normal occupation or work that you carried out immediately before becoming disabled. You will need to be working in this occupation on a full time basis to be able to qualify for the own occupation definition of TPD. Represents a superannuation service, which forms part of The Avanteos Superannuation Trust, the Symetry Personal Retirement Fund, the encircle Superannuation Fund or the Ultimate Superannuation Fund. The total monthly value of your income from your own occupation averaged over the 12 months immediately prior to you becoming disabled. If you have been employed for less than 12 months prior to becoming disabled, then the total monthly value of income will be averaged over the period since you last commenced employment but subject to a minimum averaging period of 6 months. 13

16 Schedule of medical condition definitions Cardiomyopathy Primary pulmonary hypertension Major head trauma Motor neurone disease Multiple sclerosis Muscular dystrophy Paraplegia Quadriplegia Hemiplegia Diplegia Tetraplegia Dementia and Alzheimer s disease Condition of impaired ventricular function of variable aetiology (often not determined) resulting in significant physical impairment, i.e. Class 3 on the New York Heart Association classification of cardiac impairment. Primary Pulmonary Hypertension associated with right ventricular enlargement established by cardiac catheterisation resulting in significant permanent physical impairment to the degree of at least Class 3 of the New York Heart Association classification of cardiac impairment. Injury to the head resulting in neurological deficit causing either: a permanent loss of at least 25% whole person function (as defined in the American Medical Association publication Guides to the Evaluation of Permanent Impairment 4th Edition or an equivalent guide to the evaluation of impairment approved by us), or the permanent and irreversible inability to perform without the assistance of another person any one of the following activities of daily living: dressing the ability to put on and take off clothing toileting the ability to use the toilet, including getting on and off mobility the ability to get in and out of bed and a chair continence the ability to control bowel and bladder function feeding the ability to get food from a plate into the mouth as certified by a consultant neurologist. Motor neurone disease diagnosed by a consultant neurologist. The unequivocal diagnosis of multiple sclerosis as confirmed by a consultant neurologist and characterised by demyelination in the brain and spinal cord evidenced by Magnetic Resonance Imaging or other investigations acceptable to us. There must have been more than one episode of well-defined neurological deficit with persisting neurological abnormalities. The unequivocal diagnosis of muscular dystrophy by a consultant neurologist. The permanent loss of use of both legs or both arms, resulting from spinal cord illness or injury. The permanent loss of use of both arms and both legs resulting from spinal cord illness or injury. The total loss of function of one side of the body due to illness or injury, where such loss of function is permanent. The total loss of function of both sides of the body due to illness or injury where such loss of function is permanent. The total and permanent loss of use of both arms and both legs, together with loss of head movement, due to brain illness or injury or spinal cord illness or injury. Clinical diagnosis of dementia (including Alzheimer s disease) as confirmed by a consultant neurologist, psycho geriatrician, psychiatrist or geriatrician. The diagnosis must confirm permanent irreversible failure of brain function resulting in significant cognitive impairment for which no other recognisable cause has been identified. Significant cognitive impairment means a deterioration in the person s Mini-Mental State Examination scores to 24 or less and deterioration would continue but for any effective treatment. Dementia related to alcohol, drug abuse or AIDS is excluded. 14

17 Parkinson s disease Blindness Loss of speech Loss of hearing Chronic lung disease Severe rheumatoid arthritis The unequivocal diagnosis of Parkinson s disease by a consultant neurologist where the consultant neurologist confirms that the condition: is the established cause of two or more of the following: muscular rigidity resting tremor bradykinesia, and has caused significant progressive physical impairment, likely to continue progressing but for any treatment benefit. The person must be following the advice and treatment of a specialist neurologist. The permanent loss of sight in both eyes, whether aided or unaided, due to illness or injury to the extent that visual acuity is 6/60 or less in both eyes or to the extent that the visual field is reduced to 20 degrees or less of arc, as certified by an ophthalmologist. The total and irrecoverable loss of the ability to produce intelligible speech as a result of permanent damage to the larnyx or its nerve supply or the speech centres of the brain. The loss must be certified by an appropriate medical specialist. Complete and irrecoverable loss of hearing, both natural and assisted, from both ears as a result of illness or injury, as certified by a specialist we consider appropriate. Permanent end stage respiratory failure with FEV1 test results of consistently less than one litre, requiring continuous permanent oxygen therapy. The unequivocal diagnosis of severe rheumatoid arthritis by a Rheumatologist. The diagnosis must be supported by, and evidence, all of the following criteria: at least a six week history of severe rheumatoid arthritis which involves three or more of the following joint areas: proximal interphalangeal joints in the hands metacarpophalangeal joints in the hands metatarsophalangeal joints in the foot, wrist, elbow, knee or ankle simultaneous bilateral and symmetrical joint soft tissue swelling or fluid (not bony overgrowth alone) typical rheumatoid joint deformity and at least two of the following criteria: morning stiffness rheumatoid nodules erosions seen on X-ray imaging the presence of either a positive rheumatoid factor or the serological markers consistent with the diagnosis of severe rheumatoid arthritis. Degenerative osteoarthritis and all other arthritidies are excluded. 15

18 Contact information How is my information handled? The privacy of your personal information is important to the Trustee. Details of the Trustee s Privacy Policy can be found in the FSG, or by contacting the Trustee or your financial adviser. How we handle your personal information is also covered in the relevant application form/s. You can contact the Trustee s Privacy Officer: Privacy Officer Avanteos Investments Limited Locked Bag 3460 GPO Melbourne VIC 3001 Ph: Fax: (03) [email protected] Who can I contact for further information? If you require further information please contact your financial adviser. Alternatively you may contact the Trustee on Where do I submit completed insurance forms? Please return completed insurance forms to: CommInsure Group Risk PO Box 321 Silverwater NSW 2128 Who can I contact if I have a complaint? Complaints resolution The Trustee has a procedure for dealing with specific enquiries or complaints relating to your insurance cover. When you make a complaint to us, we will do everything we can to understand, investigate and resolve the issue. If you have an enquiry or wish to lodge a complaint, please contact: Customer Liaison Officer Avanteos Investments Ltd Locked Bag 3460 GPO Melbourne VIC 3001 Telephone [email protected] If we are unable to provide a final response to your complaint within 90 days, we will: inform you of the reasons for the delay advise you of your right to complain to the Superannuation Complaints Tribunal (SCT) provide you with the SCT contact details. External dispute resolution If you are not happy with the response we provide, you may refer your complaint to an external dispute resolution service. The SCT is a Commonwealth body that deals with certain categories of complaints. You can contact the SCT from anywhere in Australia on or , or at the following address: Superannuation Complaints Tribunal Locked Bag 3060 GPO Melbourne VIC [email protected] 16

19

20 19092/0313

21 FirstWrap Group Life Rates Monthly Premium rate per $100,000 sum insured Life Insurance only Life and TPD Insurance Male Female Male Female n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker te: Rates include GST and an adviser Commission of 33% Please contact your adviser and refer to the Product Disclosure Statement and LifeProtect Insurance Brochure for further information Avanteos Investments Limited Trustee ABN Fund ABN AFS License

22 FirstWrap Group Life Rates Monthly Premium rate per $100,000 sum insured Life Insurance only Life and TPD Insurance Male Female Male Female n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Occupational Adjustments Life Insurance only Life & TPD Insurance TPD Definition Occupation Classification 'Any' Occupation Own' Occupation Professional 90% 87.5% 102.8% Clerical 100% 100% n/a n Manual Blue 100% 110% n/a Light Manual 115% 150% n/a Heavy Manual 130% 200% n/a Hazardous 250% n/a n/a te: Rates include GST and an adviser Commission of 33% Please contact your adviser and refer to the Product Disclosure Statement and LifeProtect Insurance Brochure for further information Avanteos Investments Limited Trustee ABN Fund ABN AFS License

23 FirstWrap Income Protection 2 year benefit period Monthly Premium rate per $1,000 sum insured Waiting Period 30 day 60 day 90 day Male Female Male Female Male Female Age next birthday n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker te: Rates include GST and an adviser Commission of 33% Please contact your adviser and refer to the Product Disclosure Statement and LifeProtect Insurance Brochure for further information Avanteos Investments Limited Trustee ABN Fund ABN AFS License

24 FirstWrap Income Protection 2 year benefit period Monthly Premium rate per $1,000 sum insured Waiting Period 30 day 60 day 90 day Male Female Male Female Male Female Age next birthday n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker Occupational Adjustments Occupation Classification Income Protection Professional 90% Clerical 100% n Manual Blue 150% Light Manual 225% Heavy Manual 350% Hazardous n/a te: Rates include GST and an adviser Commission of 33% Please contact your adviser and refer to the Product Disclosure Statement and LifeProtect Insurance Brochure for further information Avanteos Investments Limited Trustee ABN Fund ABN AFS License

25 FirstWrap Income Protection to age 65 benefit period Monthly Premium rate per $1,000 sum insured Waiting Period 30 day 60 day 90 day Male Female Male Female Male Female Age next birthday n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker te: Rates include GST and an adviser Commission of 33% Please contact your adviser and refer to the Product Disclosure Statement and LifeProtect Insurance Brochure for further information Avanteos Investments Limited Trustee ABN Fund ABN AFS License

26 FirstWrap Income Protection to age 65 benefit period Monthly Premium rate per $1,000 sum insured Waiting Period 30 day 60 day 90 day Male Female Male Female Male Female Age next birthday n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker n smoker Smoker Occupational Adjustments Occupation Classification Income Protection Professional 90% Clerical 100% n Manual Blue 150% Light Manual 225% Heavy Manual 350% Hazardous n/a te: Rates include GST and an adviser Commission of 33% Please contact your adviser and refer to the Product Disclosure Statement and LifeProtect Insurance Brochure for further information Avanteos Investments Limited Trustee ABN Fund ABN AFS License

27 LifeProtect Application Form - A1 Please complete this Application form if you are applying for Life only or Life and Total and Permanent Disablement (TPD) insurance cover up to $400,000. For higher cover amounts, or if you are also applying for income protection cover, please complete Form A2. Please write in BLOCK LETTERS and use a black ballpoint pen. A Insured details Investor account number Title Mr Mrs Ms Miss Other Surname Given name(s) Postal address Are you a member of a Superannuation Service with insurance cover administered by Avanteos Investments Limited? Sex Male Female Date of birth Have you smoked in the last 12 months? Are you a permanent resident of Australia? Please provide details below State Postcode Country Main occupation Do you work (on average) less than 15 hours per week or more than 60 hours per week? Annual salary (including average bonus for last 3 years) $ B Insurance cover Please read the duty of disclosure in Section F before completing this Personal Statement. Type of insurance being applied for Life only Amount of cover $ OR Life and TPD Please provide details below Amount of Life cover Amount of TPD cover $ $ Occupation type (only applicable for TPD cover for professional employees) Own Any te: When applying for Life and TPD, the TPD cover amount cannot exceed the Life cover amount. Do you wish to apply indexation (CPI) to your selected level of Life only, or Life and TPD cover? Page 1 of CommInsure is a registered business name of The Colonial Mutual Life Assurance Society Limited ABN AFSL (CMLA)

28 C Occupation risk rating 1 Are the duties of your occupation limited to Professional, Managerial, Administrative, Clerical, Secretarial or similar white collar tasks which do not involve manual work and are undertaken entirely (or at least 80%) within an office environment (excluding travel time from one office environment to another)? 2 Are you earning in excess of $80,000 per annum from your profession? 3 Are the duties of your occupation limited to the supervision of manual workers (with no hands on involvement in manual work), site inspections or a sales representative with at least 80% of your time spent out of the office? 4 Are you in a skilled occupation with a light amount of manual work (less than 20%)? 5 Does your occupation involve any of the following: driving in excess of 800 kilometres from base, flying other than as a fare paying passenger, working at heights over 15 metres, working offshore or in the mining or oil and gas industries, working on production lines or performing unskilled factory work, scuba diving or handling explosives or weapons? D Short personal statement If you answer to any of the questions below, please DO NOT continue completing Form A1. Instead, complete Form B - Full Personal Statement. 1 Are you currently unable, due to injury or illness, to carry out the identifiable duties of your occupation on a full time basis; or have you been unable to work due to injury or illness for a total of 2 weeks or more in the last 3 years? * Full time basis is considered to be at least 30 hours per week, even though you may not actually be currently working that number of hours. 2 Has an application for life, disability, trauma, accident or sickness insurance on your life ever been declined, deferred or accepted with a loading, exclusion or special terms OR have you ever claimed a benefit from any source, eg. TPD or terminal illness benefit from any superannuation fund, Workers Compensation, Disability Pension, Veterans Affairs or any other insurance policy providing accident or sickness benefits? 3 Other than the contraceptive pill and inhaled asthma medication, have you been advised to take or been prescribed medication (by a medical practitioner) that has intended to be used for three months or longer (within the last year) including but not limited to blood pressure, cholesterol, diabetes, oral steroids for asthma or depression medication? 4 Have you ever received medical advice, or undergone any medical treatment, investigation or an operation, been diagnosed or tested positive for, are you contemplating surgery or been hospitalised within the last 5 years for: AIDS (Acquired Immune Deficiency Syndrome), HIV (Human Immunodeficiency Virus) and/or Hepatitis B and/or C, cancer, heart complaint including chest pain, alcohol or drug abuse, stroke, paralysis, neurological disorder including epilepsy, multiple sclerosis, mental or nervous disorder, degenerative musculoskeletal condition, disorders of the kidney, bladder, prostate, ovaries, bowel or liver? 5 Please provide the following details: Height cm or ft/ins Weight kgs or st/lbs Page 2 of 4

29 E Privacy of your personal information How We Handle Your Personal Information Personal information is information or opinion that allows others to identify you. It includes your name, age, gender, contact details as well as your health and financial information. CommInsure are part of the Commonwealth Bank Group. We will act to protect your personal information in accordance with the National Privacy Principles or an industry privacy code. The Group is a collection of related organisations that provide banking, finance, insurance, funds management, financial planning and advice, superannuation, stockbroking and other services. The Group values your trust and aims to help you manage and build wealth over a long period. The protection of your personal information is a vital part of this relationship. It is supported by our long experience of keeping personal information confidential. We collect personal information to provide you with the products and services you request as well as information on other products and services offered by or through us. The law may also require us to collect personal information. We will tell you who collects the personal information, advise you of their contact details, your right of access to that information and what will happen if you choose not to provide the information. Personal information may be used and disclosed within the Group to administer our products and services, as well as for prudential and risk management purposes and, unless you tell us otherwise, to provide you with related marketing information. We also use the information we hold to help detect and prevent illegal activity. We co-operate with police and other enforcement bodies as required or allowed by law. We disclose relevant personal information to external organisations that help us provide services. These organisations are bound by confidentiality arrangements. They may include overseas organisations. You can seek access to the personal information we hold about you. If the information we hold about you is inaccurate, incomplete or outdated, please inform us so that we can correct it. If we deny access to your personal information, we will let you know why. For example, we may give an explanation of a commercially sensitive decision, rather than direct access to evaluative information connected with it. Further information and feedback If you have any questions or would like further information on our privacy and information handling practices, please contact us by: at [email protected] Telephone *, or writing to the address below: Privacy Officer Customer Relations Commonwealth Bank Group Reply Paid 41 Sydney NSW 2001 * A free call unless made from a mobile phone, which will be charged at the applicable mobile rate. F Duty of disclosure Your duty of disclosure Before you enter into or become insured under a contract of life insurance with an insurer, 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, is relevant to the insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the insurer before you extend, vary or reinstate life insurance. 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, or as to which compliance with your duty is waived by the insurer. n-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 questions may delay the assessment of this application Page 3 of 4

30 G Declaration This section must be completed in all circumstances. I have read the Duty of Disclosure in this Personal Statement and I am aware of the consequences of non-disclosure. I understand that the Duty of Disclosure continues after I have completed this statement until my application for cover has been accepted by The Colonial Mutual Life Assurance Society Limited ABN and (CMLA) in writing. I authorise: the insurer to refer any statements that have been made in connection with my application for cover and any medical reports to other entities involved in providing or administering the insurance (for example, reinsurers, medical consultants, legal advisers) the insurer and any person appointed by the insurer to obtain information on my medical claims and financial history from the Insurance Reference Association and any other body holding information on me. any hospital, doctor or other person who has treated or examined me to give to CMLA any information on my illness or injury, medical history, consultation, prescription or treatment or copies of all hospital or medical reports. I declare that: the answers to questions and the declarations on this Personal Statement are true and correct (including those not in my own handwriting) I have not withheld any information which may affect CMLA s decision to provide insurance. I acknowledge that the answers I have provided, together with any special conditions, will form the basis of the contract of insurance. I have read and understood the Privacy section of the Superannuation Service PDS or the LifeProtect Insurance brochure. I acknowledge and consent to the use and disclosures of my personal information as detailed in that section. I acknowledge that the answers I have provided, together with any special conditions, will form the basis of the contract of insurance. I have read and understood Privacy of your Personal Information in Section E of this Personal Statement. I acknowledge and consent to the use and disclosures of my personal information as detailed in that section. I have read and understood the obligations outlined in the Duty of Disclosure in Section F of this Personal Statement. A photocopy of this authorisation is as valid as the original. I agree to provide further medical authorities if requested. Please be aware that CommInsure may request further medical evidence as a result of the answers given in this Personal Statement. Print name Signature of the person to be insured Date Please return the completed form, with attachments to: CommInsure Group Risk, PO Box 321, Silverwater NSW 2128 If you have any questions or require assistance please call Adviser use only 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 login (Avanteos Platform) Dealer/Adviser stamp (please use black ink only) Phone number ( ) Mobile phone number Fax number ( ) Dealer group Adviser name Adviser commission percentage Page 4 of 4

31 LifeProtect and Income Protection Application Form - A2 Please complete this Application form if you are applying for Life, Total and Permanent Disablement (TPD) insurance cover up to $800,000, or Income Protection cover up to $6,000 per month. For higher cover amounts please complete Form B - Full Personal Statement. Please write in BLOCK LETTERS and use a black ball point pen. A Insured details Investor account number Title Mr Mrs Ms Miss Other Surname Given name(s) Postal address Are you a member of a Superannuation Service with insurance cover administered by Avanteos Investments Limited? Sex Male Female Date of birth Have you smoked in the last 12 months? Are you a permanent resident of Australia? Please provide details below State Postcode Country Main occupation Do you work (on average) less than 15 hours per week or more than 60 hours per week? Annual salary (including average bonus for last 3 years) $ B Insurance cover Please read the duty of disclosure in Section F before completing this Personal Statement. Type of insurance being applied for: Life only Amount of cover OR Life and TPD Amount of Life cover $ AND/OR Income Protection Waiting period 30 days 60 days 90 days $ Please provide details below Amount of TPD cover $ Occupation type (only applicable for TPD cover for professional employees) Own Any te: When applying for Life and TPD, the TPD cover amount cannot exceed the Life cover amount. Amount of cover $ Benefit period 2 years To age 65 Do you wish to apply indexation (CPI) to your selected level of Life only, or Life and TPD cover? per month (this cannot be greater than 75% of your monthly income) Do you wish to apply indexation (CPI) to your selected level of Income Protection cover? Page 1 of CommInsure is a registered business name of The Colonial Mutual Life Assurance Society Limited ABN AFSL (CMLA)

32 C Occupation risk rating 1 Are the duties of your occupation limited to Professional, Managerial, Administrative, Clerical, Secretarial or similar white collar tasks which do not involve manual work and are undertaken entirely (or at least 80%) within an office environment (excluding travel time from one office environment to another)? 2 Are you earning in excess of $80,000 per annum from your profession? 3 Are the duties of your occupation limited to the supervision of manual workers (with no hands on involvement in manual work), site inspections or a sales representative with at least 80% of your time spent out of the office? 4 Are you in a skilled occupation with a light amount of manual work (less than 20%)? 5 Does your occupation involve any of the following: driving in excess of 800 kilometres from base, flying other than as a fare paying passenger, working at heights over 15 metres, working offshore or in the mining or oil and gas industries, working on production lines or performing unskilled factory work, scuba diving or handling explosives or weapons? D Short personal statement If you answer to any of the questions below, please DO NOT continue completing Form A2. Instead, complete Form B - Full Personal Statement 1 Will the combined amount of total cover that you are requesting (including any existing cover) exceed $800,000 for Life only or Life and TPD, or $6,000 per month for Income Protection cover? 2 Do you engage in any hazardous pastimes or pursuits such as but not limited to: motorised sports, parachuting, hang-gliding, abseiling or other mountaineering related activities, aviation other than as a fare paying passenger (including ballooning), scuba diving more than 40 metres or any sport(s) in a professional capacity? 3 Do you intend to travel or reside overseas for more than 6 months in the next 2 years? 4 Have you received any medical advice, or undergone any medical treatment, investigation or an operation, suffered from or are you contemplating surgery for any illness or injury that would affect your long term health and require ongoing medical supervision. This includes but is not limited to: Cancer or diabetes High blood pressure, cholesterol or heart complaint Alcohol or drug abuse Stroke, paralysis, neurological disorder or multiple sclerosis? 5 Have you received any medical advice, or undergone any medical treatment, investigation or an operation, suffered from or are you contemplating surgery for any of the following: Any injury or complaint of the back, neck, knee or shoulder requiring time off work in the last 12 months AND/OR any disease, disorder or degeneration of the muscles, tendons, bones, discs or joints? Loss of the sight of an eye or the total and permanent loss of the use of a limb ( limb includes whole hand or whole foot)? Depression or mental disorder (including but not limited to stress, anxiety, chronic tiredness or fatigue, panic attacks, post traumatic stress, behavioural or nervous disorder)? Chest pain, asthma, bronchitis or any other lung complaint requiring hospitalisation within the last five years? Disorders of the kidney, bladder, prostate, ovaries, gall bladder, bowel or liver? Epilepsy? 6 Has an application for life, disability, trauma, accident or sickness insurance on your life ever been declined, deferred or accepted with a loading, exclusion or special terms? 7 Are you claiming, or have you ever claimed any type of disability benefit from any source, e.g. TPD or terminal illness benefit from any superannuation fund, Workers Compensation, Disability Pension, Veterans Affairs or any other insurance policy providing accident or sickness benefits? 8 Are you at the date of the application, due to injury, accident or illness: Off work? Restricted from being capable of performing your full and normal duties on a full time basis (for at least 30 hours per week), even though your actual employment can be on a full time, part time or casual basis? 9 Please provide the following details: Height cm or ft/ins Weight kgs or st/lbs 10 Excluding the contraceptive pill and inhaled asthma medication, have you been advised to take or been given prescribed medication by a medical practitioner that has intended to be used for three months or longer within the last year (including but not limited to blood pressure, diabetes, oral steroids for asthma or depression medication)? 11 Have you been unable to work because of sickness or injury for more than two consecutive weeks in the last three years? 12 Have you been infected with or have you ever been tested positive for AIDS (Acquired Immune Deficiency Syndrome), HIV (Human Immunodeficiency Virus) or Hepatitis B and/or C? Page 2 of 4

33 E Privacy of your personal information How We Handle Your Personal Information Personal information is information or opinion that allows others to identify you. It includes your name, age, gender, contact details as well as your health and financial information. CommInsure are part of the Commonwealth Bank Group. We will act to protect your personal information in accordance with the National Privacy Principles or an industry privacy code. The Group is a collection of related organisations that provide banking, finance, insurance, funds management, financial planning and advice, superannuation, stockbroking and other services. The Group values your trust and aims to help you manage and build wealth over a long period. The protection of your personal information is a vital part of this relationship. It is supported by our long experience of keeping personal information confidential. We collect personal information to provide you with the products and services you request as well as information on other products and services offered by or through us. The law may also require us to collect personal information. We will tell you who collects the personal information, advise you of their contact details, your right of access to that information and what will happen if you choose not to provide the information. Personal information may be used and disclosed within the Group to administer our products and services, as well as for prudential and risk management purposes and, unless you tell us otherwise, to provide you with related marketing information. We also use the information we hold to help detect and prevent illegal activity. We co-operate with police and other enforcement bodies as required or allowed by law. We disclose relevant personal information to external organisations that help us provide services. These organisations are bound by confidentiality arrangements. They may include overseas organisations. You can seek access to the personal information we hold about you. If the information we hold about you is inaccurate, incomplete or outdated, please inform us so that we can correct it. If we deny access to your personal information, we will let you know why. For example, we may give an explanation of a commercially sensitive decision, rather than direct access to evaluative information connected with it. Further information and feedback If you have any questions or would like further information on our privacy and information handling practices, please contact us by: at [email protected] Telephone *, or writing to the address below: Privacy Officer Customer Relations Commonwealth Bank Group Reply Paid 41 Sydney NSW 2001 * A free call unless made from a mobile phone, which will be charged at the applicable mobile rate. F Duty of disclosure Your duty of disclosure Before you enter into or become insured under a contract of life insurance with an insurer, 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, is relevant to the insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the insurer before you extend, vary or reinstate life insurance. 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, or as to which compliance with your duty is waived by the insurer. n-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 questions may delay the assessment of this application Page 3 of 4

34 G Declaration This section must be completed in all circumstances. I have read the Duty of Disclosure in this Personal Statement and I am aware of the consequences of non-disclosure. I understand that the Duty of Disclosure continues after I have completed this statement until my application for cover has been accepted by The Colonial Mutual Life Assurance Society Limited ABN and (CMLA) in writing. I authorise: the insurer to refer any statements that have been made in connection with my application for cover and any medical reports to other entities involved in providing or administering the insurance (for example, reinsurers, medical consultants, legal advisers) the insurer and any person appointed by the insurer to obtain information on my medical claims and financial history from the Insurance Reference Association and any other body holding information on me. any hospital, doctor or other person who has treated or examined me to give to CMLA any information on my illness or injury, medical history, consultation, prescription or treatment or copies of all hospital or medical reports. I declare that: the answers to questions and the declarations on this Personal Statement are true and correct (including those not in my own handwriting) I have not withheld any information which may affect CMLA s decision to provide insurance. I acknowledge that the answers I have provided, together with any special conditions, will form the basis of the contract of insurance. I have read and understood the Privacy section of the Superannuation Service PDS or the LifeProtect Insurance brochure. I acknowledge and consent to the use and disclosures of my personal information as detailed in that section. I acknowledge that the answers I have provided, together with any special conditions, will form the basis of the contract of insurance. I have read and understood Privacy of your Personal Information in Section E of this Personal Statement. I acknowledge and consent to the use and disclosures of my personal information as detailed in that section. I have read and understood the obligations outlined in the Duty of Disclosure in Section F of this Personal Statement. A photocopy of this authorisation is as valid as the original. I agree to provide further medical authorities if requested. Please be aware that CommInsure may request further medical evidence as a result of the answers given in this Personal Statement. Print name Signature of the person to be insured Date Please return the completed form, with attachments to: CommInsure Group Risk, PO Box 321, Silverwater NSW 2128 If you have any questions or require assistance please call Adviser use only 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 login (Avanteos Platform) Dealer/Adviser stamp (please use black ink only) Phone number ( ) Mobile phone number Fax number ( ) Dealer group Adviser name Adviser commission percentage Page 4 of 4

35 Short Personal Statement (Form A) Complete this form if you are applying for Death only, Death and TPD or Income Protection cover for amounts: less than and including $6,000 per month for Income Protection cover; and/or less than and including $600,000 for Death only or Death and TPD cover. If the cover applied for does not fall into the above range, please complete Full Personal Statement (Form B). Please carefully read the information in the PDS before completing this Short Personal Statement (Form A). A - Your details Membership number Surname Given name/s Date of birth B - Personal health details If you answer to any of the questions below, please do not continue completing this form. Instead, complete the Full Personal Statement (Form B). 1 Has an application for life, disability, trauma, accident or sickness insurance on your life ever been declined, deferred or accepted with a loading, exclusion or special terms? 2 Are you claiming or have you ever claimed a benefit from any source, eg. TPD benefit from any superannuation fund, worker s compensation, disability pension, Veterans Affairs pension or any other insurance policy providing accident or sickness benefits? 3 Are you at the date of this application, due to injury, accident or illness: a off work? b restricted from being capable of performing your full and normal duties on a full-time basis (for at least 30 hours per week), even though your actual employment can be on a full-time, part-time or casual basis? 4 Have you lost the sight of an eye or the total and permanent loss of the use of a limb ( limb includes whole hand or whole foot)? 5 Please provide the following details: Height cm or ft/ins Weight kg or st/lbs 6 Excluding the contraceptive pill and inhaled asthma medication, have you been advised to take, or been given prescribed medication by a medical practitioner that has intended to be used for three months or longer within the last year (including but not limited to blood pressure, diabetes, oral steroids for asthma or depression medication)? 7 Have you been unable to work because of sickness or injury for more than two consecutive weeks in the last three years? 8 Have you undergone any medical treatment, investigation or an operation, suffered from or are you contemplating surgery for any illness or injury that would affect your longterm health and require ongoing medical supervision. This includes, but is not limited to: cancer or diabetes high blood pressure, cholesterol or any heart complaint alcohol or drug abuse stroke, paralysis, neurological disorder or multiple sclerosis 9 Have you been infected with, or have you ever tested positive for AIDS (Acquired Immune Deficiency Syndrome), HIV (Human Immunodeficiency Virus) or hepatitis B and C? Page of 2 CI CommInsure is a registered business name of The Colonial Mutual Life Assurance Society Limited ABN AFSL (CMLA)

36 10 Have you received any medical advice, or undergone any medical treatment, investigation or an operation, suffered from or are you contemplating surgery, for any of the following: a Any injury or complaint of the back, neck, knee or shoulder requiring time off work in the last twelve months and/or any disease, disorder or degeneration to the muscles, tendons, bones, discs or joints? b Depression or mental disorder (including but not limited to stress, anxiety, chronic tiredness or fatigue, panic attacks, post traumatic stress, behavioural or nervous disorder)? c Chest pain, asthma, bronchitis or any other lung complaint requiring hospitalisation within the last five years? d Disorders of the kidney, bladder, prostate, ovaries, gall bladder, bowel, or liver? e Epilepsy? C - Duty of disclosure Before you enter into, or become insured, under a contract of life insurance with an insurer, 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, is relevant to the insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the insurer before you extend, vary or reinstate your insurance. 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 or as to which compliance with your duty is waived by the insurer. n-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 avoid the cover within three years of issuing it. If your non-disclosure is fraudulent, the insurer may avoid your cover at any time. An insurer who is entitled to avoid your cover may, within three years of issuing it, elect not to avoid 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. D - Declaration This section must be completed in all circumstances. I have read the Duty of disclosure in Section C of this Personal Statement and I am aware of the consequences of nondisclosure. I understand that the Duty of disclosure continues after I have completed this statement until my application for cover has been accepted by The Colonial Mutual Life Assurance Society Limited ABN (CMLA) in writing. I authorise: the insurer to refer any statements that have been made in connection with my application for cover and any medical reports to other entities involved in providing or administering the insurance (for example reinsurers, medical consultants, legal advisers) the insurer and any person appointed by the insurer to obtain information on my medical claims and financial history from the Insurance Reference Association and any other body holding information on me. I declare that: the answers to all the questions and the declarations on this Personal Statement are true and correct (including those not in my own handwriting) I have not withheld any information which may affect CMLA s decision to provide insurance. I acknowledge that the answers I have provided, together with any special conditions, will form the basis of the contract of insurance. I have read and understood the Privacy section of the PDS. I acknowledge and consent to the use and disclosures of my personal information as detailed in that section. Full name Signature of life to be insured Date CI Page 2 of 2

37 Full Personal Statement (Form B) Complete this form if you are applying for Life only, Life and TPD or Income Protection cover for: more than $6,000 per month for Income Protection cover; more than $800,000 for Life only or Life and TPD cover; or if you answer to any questions in Section D of Short Form A1 or A2. A Insured details Investor account number Title Mr Mrs Ms Miss Other Surname Given name(s) Are you a member of a Superannuation Service with insurance cover administered by Avanteos Investments Limited? Sex Male Female Date of birth Postal address Are you a permanent resident of Australia? Please provide details below State Postcode Country Main occupation Do you work (on average) less than 15 hours per week or more than 60 hours per week? Annual salary (including average bonus for last 3 years) $ B Insurance cover Please read the duty of disclosure in Section N before completing this Personal Statement. Type of insurance being applied for: Life only OR Life and TPD Amount of Life cover $ AND/OR Income Protection Waiting period 30 days 60 days 90 days Amount of cover $ Please provide details below Amount of TPD cover $ Occupation type (only applicable for TPD cover for professional employees) Own Any te: When applying for Life and TPD, the TPD cover amount cannot exceed the Life cover amount. Amount of cover $ Do you wish to apply indexation (CPI) to your selected level of Income Protection cover? Benefit period 2 years To age 65 Do you wish to apply indexation (CPI) to your selected level of Life only, or Life and TPD cover? per month (this cannot be greater than 75% of your monthly income) Page 1 of 11 CIL CommInsure is a registered business name of The Colonial Mutual Life Assurance Society Limited ABN AFSL (CMLA) a wholly owned, but non-guaranteed subsidiary of the Commonwealth Bank of Australia ABN

38 C Occupation risk rating 1 Are the duties of your occupation limited to Professional, Managerial, Administrative, Clerical, Secretarial or similar white collar tasks which do not involve manual work and are undertaken entirely (or at least 80%) within an office environment (excluding travel time from one office environment to another)? 2 Are you earning in excess of $80,000 per annum from your profession? 3 Are the duties of your occupation limited to the supervision of manual workers (with no hands on involvement in manual work), site inspections or a sales representative with at least 80% of your time spent out of the office? 4 Are you in a skilled occupation with a light amount of manual work (less than 20%)? 5 Does your occupation involve any of the following: driving in excess of 800 kilometres from base, flying other than as a fare paying passenger, working at heights over 15 metres, working offshore or in the mining or oil and gas industries, working on production lines or performing unskilled factory work, scuba diving or handling explosives or weapons? D Insurance history details 1 Other than this application, do you have or have you recently applied for life, total and permanent disability, trauma or income protection insurance on your life with CommInsure or any other insurance company? 2 Has an application for life, disability, trauma, accident or sickness insurance on your life ever been declined, deferred or accepted with a loading, exclusion or special terms? Please provide details below Fund or insurance company name Type of cover Insurance benefit Please provide details below Fund or insurance company name Date commenced Terms offered and reason To be replaced? Policy Number Date commenced $ $ 3 Are you claiming or have you ever claimed a benefit from any source, e.g. TPD benefit from any superannuation fund, workers compensation, disability pension, Veterans Affairs pension or any other insurance policy providing accident or sickness benefits? Please provide details below Benefit type/source/reason for claim Claim date Claim amount Date claim finalised $ $ E Activities and pastimes 1 Do you currently engage in, or intend to engage in, any of the following sports or hazardous activities: Tick ( ) yes or no Flying (other than as a fare paying passenger on a commercial airline)? Underwater diving? (Maximum Depth m) Motor sports of any kind, e.g. rally driving, trail bike riding, ocean racing? Football of any code (including touch football or Oz tag)? Any other sport or hazardous activities, e.g. parachuting, hang-gliding, body contact sports, paragliding, competitive water sports or recreations involving heights? If you answered to any of the above, please provide further details below What are the activity/ies you engage in? CIL Page 2 of 11

39 E - Activities and pastimes continued At what level do you participate? Tick ( the appropriate box Recreational only (non-competition) Recreational with competition Semi-professional/professional Number of times you participate on average in this activity/ies per annum (e.g. hours flown, number of drives, events etc.) Tick ( ) yes or no Do you receive income from participating in this activity/ies? F Personal health details 1 What is your height and current weight? Height cm or ft/ins kg 2 Have you smoked tobacco, or any other substance, at any time during the last twelve months? Weight or st/lbs Please indicate type (e.g. cigarettes, cigars, etc.) and average amount smoked below Substance smoked Per day Per week Per year 3 Do you drink alcohol? Please provide the average number of drinks consumed Per day Per week Per year G Family history 1 Have any of your immediate family (parents, brothers, sisters) suffered from, or been diagnosed with, any of the following: a Heart problems, stroke, high blood pressure, diabetes? Unknown b Cancer (breast, ovarian, cervical, bowel or other)? (please specify type) Please complete the table in (c) below c Any other inherited or hereditary disease (e.g. huntington s disease, polycystic kidney, muscular dystrophy, familial polyposis, etc.)? (please specify type) Family member Condition Approximate age of onset Age at death (if applicable) CIL Page 3 of 11

40 H - Doctor details 1 What is the name and address of the last doctor or medical centre you visited? Full name of doctor Phone number ( ) Address 2 a When did you last see a doctor? Within the last month 1 to 3 months ago 3 to 6 months ago 6 to 12 months ago 12 months to 2 years ago Over 2 years ago b Reason for last consultation? State Facsimile number ( ) Postcode c What was the result/outcome from your last consultation? (please tick ( the appropriate box) Referral to specialist/health professional Tests conducted results pending t fully recovered yet Ongoing treatment (e.g. ventolin inhaler) Routine tests conducted results all clear/normal All clear/normal/full recovery no tests or prescribed treatment required (other than contraceptive and cold/flu medication) 3 Is the doctor/medical centre mentioned above your usual doctor/medical centre? 4 How long have you been a patient of this doctor or medical centre? Years Months If less than 12 months, please provide details of your previous doctor/medical centres. Full name of doctor Phone number ( ) Address State Facsimile number ( ) Postcode I Lifestyle declaration To the best of your knowledge, is there any possibility that you have ever been infected with, or have you ever tested positive for, AIDS (Acquired Immune Deficiency Syndrome), HIV (Human Immunodeficiency Virus) or hepatitis, or are you in a high-risk category (eg injected drugs other than as prescribed by a medical practitioner, shared needles, engaged in unprotected male to male sexual intercourse, worked as or, engaged the services of a prostitute)? Please provide details below Please note: If you answered to the declaration above, you will be asked to complete a specific lifestyle questionnaire. CIL Page 4 of 11

41 J Medical history Have you ever had, or sought advice or treatment, experienced symptoms, or suffered from any of the following: Tick ( ) yes or no 1 Asthma, bronchitis or any other lung complaint? 2 Cysts, moles, sunspots or skin lesions? 3 Back, neck, shoulder, knee, elbow complaints, sciatica, disc or spine complaints, or injury of the joints, bones or muscles? 4 Depression or mental disorder (including but not limited to stress, anxiety, panic attacks, behavioural or nervous disorder)? 5 Diabetes or abnormal blood sugar 6 Chest pains, heart complaint, heart murmur, high blood pressure, raised cholesterol, palpitations or rheumatic fever? 7 Stroke, paralysis, neurological disorder, multiple sclerosis or blood vessel disorder? 8 Cancer, tumour or melanoma? 9 Thyroid, glandular or pancreatic disorder? 10 Gastric or duodenal ulcer, persistent indigestion, irritable bowel or other bowel disorder? 11 Any disorder of the gall bladder or liver (including hepatitis B, C or raised liver function)? 12 Varicose veins, haemorrhoids or hernia? 13 Disorder of the kidney, bladder or prostate, blood in urine or kidney stones? 14 Epilepsy, fits of any kind, fainting episodes, or recurring headaches or migraines? 15 Chronic fatigue syndrome, lethargy, sleep apnoea or any sleeping disorder? 16 Arthritis, gout, osteoporosis, fibromyalgia, Repetitive Strain Injury (RSI) or any chronic pain syndrome? 17 Eczema, dermatitis, psoriasis, or any other skin disorder? 18 Anaemia, leukaemia, haemophilia, haemochromotosis or any other blood disorder? 19 Any impairment of sight (other than corrected by glasses or lenses) or blurred vision? 20 Any impairment of hearing, including tinnitus, or speech? 21 Any sexually transmitted diseases? 22 Any other illness, injury, disease or disorder not mentioned above? 23 Other than those conditions mentioned above, are you taking any regular prescribed medication (excluding contraceptives)? 24 Within the last three years, have you had: Any blood tests which revealed an abnormality? Any tests such as ECG, X-ray (excluding broken bones or joint strains), genetic test or ultrasound (other than for pregnancy)? 25 Are you considering seeking medical advice, treatment, tests or surgery in the future? 26 Have you ever had a genetic test? Females Only 27 Are you currently pregnant? If yes: due date for birth of baby? 28 Have you ever had any complications with pregnancy or childbirth (e.g. diabetes, ectopic pregnancy)? If yes: please provide details below Please note: If you have answered to question 1 to 4 above, we will ask you to complete a Specific questionnaire on the related condition. These questionnaires can be found in Section K on page 6-8 If you answered to question 5-26 above, please provide full details in Section L General health questionnaire on page 9. CIL Page 5 of 11

42 K - Specific medical questionnaires If you have answered to any of questions 1 to 4 in Section J, please complete the relevant specific questionnaire below. 1 Asthma, bronchitis or any other lung complaint questionnaire a Name of condition b Have you been diagnosed within the last 12 months? c Frequency of symptoms in the last five years (please tick ( ) the appropriate boxes) Daily Weekly Occasionally One-off episode ne - childhood only d Severity of symptoms in the last five years (please tick ( ) the appropriate boxes) Nil symptoms - childhood only Mild, i.e. exercise-induced only, seasonal (related to hay fever allergy, colds or flu) Moderate, i.e. all year round, no specific triggers Severe, i.e. constant, reduced lung capacity, restriction of lifestyle or work duties e Have you required over the last five years: Tick ( ) yes or no Daily preventative inhalers, eg Ventolin Occasional use of a nebuliser or oral steroid medication, eg prednisolone Hospitalisation / Emergency treatment f Maximum number of consecutive days off work / school you have had over the last two years due to this condition Days g Is your treating doctor different from your usual doctor? Please provide details below Full name of doctor Address Phone number ( ) State Facsimile number ( ) Postcode 2 Cysts, moles, sunspots or skin lesions questionnaire a Please provide type (e.g. cyst, mole, melanoma) b Location of growth(s) (eg face, back, right arm) c When was this? d Was/Were the growth(s) removed? Please provide details below When was/were it/they removed? Number removed Method of removal? Tick ( ) the appropriate box Frozen off / Burnt off e Were any further special tests, investigations, treatments or follow-up required? Surgically removed / Cut out Please provide details below f Was/Were the growth(s) reported to be cancerous (malignant)? g Was the doctor you consulted different from your usual doctor? Please provide details below Full name of doctor Address Phone number ( ) State Facsimile number ( ) Postcode CIL Page 6 of 11

43 K - Specific medical questionnaires (continued) If you have answered to any of questions 1 to 4 in Section J, please complete the relevant specific questionnaire below. 3 Joint / Musculoskeletal questionnaire If you are applying for Life cover only, please complete questions (a) and (b) only, otherwise please complete all questions. a Nature of complaint (doctor s diagnosis) eg sciatica, back pain, broken bone b Location of complaint e.g. lower back, right knee, sciatic nerve c When did the symptoms first begin? d Cause of condition, e.g. lifting, car accident, fall in workplace, unknown e Was an X-ray or scan taken? Please provide details below Date of test taken Details of results of tests taken f Is the nature of the condition degenerative or a disc problem? g Are you still undergoing treatment or experiencing symptoms? Please complete below Date symptoms ceased Date treatment ceased h Have you ever been off work as a result of this complaint or been unable to perform your normal day-to-day activities? Please indicate period(s) off work below Date from Date to i Do you have any residual, ongoing effects or restrictions as a result of this condition? Please provide dates and details below j Is your treating doctor different from your usual doctor? Please provide details below Full name of doctor Address Phone number ( ) State Facsimile number ( ) Postcode CIL Page 7 of 11

44 K - Specific medical questionnaires (continued) If you have answered to any of questions 1 to 4 in Section J, please complete the relevant specific questionnaire below. 4 Anxiety / Depression questionnaire a Provide details of the condition (doctor s diagnosis) b Please indicate the reason or cause by ticking ( ) the appropriate box(es) Bereavement / Family illness Marital problems Post natal Work related Other c Date symptoms first commenced d Date symptoms ceased or ongoing e Have you taken or are you taking medication? Please provide details of the type of medication below (including dosage) f Are you currently on medication? g Have you ever been hospitalised? Date from Please provide details below Date to h Did the condition ever cause you to lose time off work? Please provide details below Years Months Days i Has your ability to work or perform daily activities been restricted in any way? Please provide dates and details below j Were any of the doctors you consulted different from your usual doctor? Please provide details below Full name of doctor Address Phone number ( ) State Facsimile number ( ) Postcode CIL Page 8 of 11

45 L - General health questionnaire If you have answered to any part of questions 5 to 26 in Section J, please complete the table below. Please ensure you write the question number in the brackets above each column. Question ( ) Question ( ) Question ( ) 1 Name of condition Date symptoms first started 3 Date symptoms ceased 4 Are these symptoms ongoing 5 How often do/did you have symptoms? Please choose one of the following: daily, weekly, monthly, quarterly, half yearly, yearly, one off, other (please specify) 6 Severity of condition Please choose from one of the following: mild, moderate, severe, never had symptoms, symptoms ceased 7 Did you take medication or have you had any other treatment (e.g. physiotherapy or an operation) for this condition? If, name the treatment/condition 8 Are you still on treatment, including medication? 9 Have you ever been off work due to this condition? If, provide details. If there is insufficient space please attach an additional sheet 10 If, also state the total time off work in days, months and years days days days months month months years years years 11 Have you had any residual, ongoing effects or restrictions as a result of this condition? If, please provide details and dates CIL Page 9 of 11

46 M Privacy of your personal information How We Handle Your Personal Information Personal information is information or opinion that allows others to identify you. It includes your name, age, gender, contact details as well as your health and financial information. CommInsure are part of the Commonwealth Bank Group. We will act to protect your personal information in accordance with the National Privacy Principles or an industry privacy code. The Group is a collection of related organisations that provide banking, finance, insurance, funds management, financial planning and advice, superannuation, stockbroking and other services. The Group values your trust and aims to help you manage and build wealth over a long period. The protection of your personal information is a vital part of this relationship. It is supported by our long experience of keeping personal information confidential. We collect personal information to provide you with the products and services you request as well as information on other products and services offered by or through us. The law may also require us to collect personal information. We will tell you who collects the personal information, advise you of their contact details, your right of access to that information and what will happen if you choose not to provide the information. Personal information may be used and disclosed within the Group to administer our products and services, as well as for prudential and risk management purposes and, unless you tell us otherwise, to provide you with related marketing information. We also use the information we hold to help detect and prevent illegal activity. We co-operate with police and other enforcement bodies as required or allowed by law. We disclose relevant personal information to external organisations that help us provide services. These organisations are bound by confidentiality arrangements. They may include overseas organisations. You can seek access to the personal information we hold about you. If the information we hold about you is inaccurate, incomplete or outdated, please inform us so that we can correct it. If we deny access to your personal information, we will let you know why. For example, we may give an explanation of a commercially sensitive decision, rather than direct access to evaluative information connected with it. Further information and feedback If you have any questions or would like further information on our privacy and information handling practices, please contact us by: at [email protected] Telephone *, or writing to the address below: Privacy Officer Customer Relations Commonwealth Bank Group Reply Paid 41 Sydney NSW 2001 * A free call unless made from a mobile phone, which will be charged at the applicable mobile rate. N Duty of disclosure Your duty of disclosure Before you enter into or become insured under a contract of life insurance with an insurer, 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, is relevant to the insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the insurer before you extend, vary or reinstate life insurance. 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, or as to which compliance with your duty is waived by the insurer. n-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 questions may delay the assessment of this application. CIL Page 10 of 11

47 O Declaration I have read the Duty of Disclosure in this Personal Statement and I am aware of the consequences of non-disclosure. I understand that the Duty of Disclosure continues after I have completed this statement until my application for cover has been accepted by The Colonial Mutual Life Assurance Society Limited ABN and (CMLA) in writing. I authorise: the insurer to refer any statements that have been made in connection with my application for cover and any medical reports to other entities involved in providing or administering the insurance (for example, reinsurers, medical consultants, legal advisers) the insurer and any person appointed by the insurer to obtain information on my medical claims and financial history from the Insurance Reference Association and any other body holding information on me. any hospital, doctor or other person who has treated or examined me to give to CMLA any information on my illness or injury, medical history, consultation, prescription or treatment or copies of all hospital or medical reports. I declare that: the answers to questions and the declarations on this Personal Statement are true and correct (including those not in my own handwriting) I have not withheld any information which may affect CMLA s decision to provide insurance. I acknowledge that the answers I have provided, together with any special conditions, will form the basis of the contract of insurance. I have read and understood Privacy of your Personal Information in Section M of this Personal Statement. I acknowledge and consent to the use and disclosures of my personal information as detailed in that section. I have read and understood the obligations outlined in the Duty of Disclosure in Section N of this Personal Statement. A photocopy of this authorisation is as valid as the original. I agree to provide further medical authorities if requested. Please be aware that CommInsure may request further medical evidence as a result of the answers given in this Personal Statement. Print name This section must be completed in all circumstances. Signature of the person to be insured Date Please return the completed form, with attachments to: CommInsure Group Risk, PO Box 321, Silverwater NSW 2128 If you have any questions or require assistance please call Adviser use only Should a blood test or a medilite be required, please indicate whether you would like us to organise for a nurse to visit your client: Adviser login (Avanteos Platform) Dealer/Adviser stamp (please use black ink only) Phone number ( ) Mobile phone number Fax number ( ) Dealer group Adviser name Adviser commission percentage CIL Page 11 of 11

48 Insurance Transfer Form You can apply to transfer insurance cover that you have outside of the Plan if you: are joining the Plan for the first time or are an existing member of the Plan; and you have superannuation with another fund where you are entitled to a life and/or total and permanent disablement (TPD) benefit and/or income protection benefit under that fund ( former fund ); or you have an individual life and/or TPD and/or income protection insurance policy outside of superannuation from a life insurer ( individual insurer ); by 1 completing PART A, B and C of this Insurance Transfer Form (below), providing all the required details and signing the form; and 2 attaching an up-to-date statement from your former fund or written evidence from your individual insurer confirming the type and level of cover you have with the former fund or individual insurer (CommInsure must receive this evidence within 45 days of it being issued). Please note that acceptance of your transfer request is subject to the CommInsure s acceptance and some limitations apply. Do not cancel your existing cover until you have received confirmation in writing that your transfer request has been accepted by CommInsure. If your application is accepted, you will receive an amount of cover equivalent to the level of cover you currently have with your former fund or individual insurer. A Insured details Investor account number Title Mr Mrs Ms Miss Other Surname Are you a member of a Superannuation Service with Insurance cover administered by Avanteos Investments Limited? Sex Male Female Given name/s Postal address State Postcode Date of birth Have you smoked in the last 12 months? Are you a permanent resident of Australia? Please provide details below Main occupation Do you work (on average) less than 15 hours per week or more than 60 hours per week? Annual Salary (including average bonus for last 3 years) $ B Personal statement and confirmation of requirements 1 Please confirm (by ticking the box to the right) that the following statements are true and correct: Tick ( ) yes or no a I will cancel all insurance cover with my former fund or individual insurer within 60 days of receiving confirmation from CommInsure of my successful transfer application; b I will not be transferring the cover with my individual insurer or former fund to any other part (including division, section or category) of the former fund, or to any other superannuation fund; and c I will not effect a continuation option, or subsequently reinstate any cancelled cover with the individual insurer, or within the former fund or any other division, section, category of the former fund, or within any fund or insurance policy where such reinstatement of cover is available to me; d I understand that my cover, once accepted, will be subject to the terms and conditions relating to insurance provided by the Plan I confirm that the above statements are true and correct and I agree to abide by these requirements If you have ticked you are not eligible to transfer your insurance. This does not affect any cover you have under the Plan. Page 1 of CommInsure is a registered business name of The Colonial Mutual Life Assurance Society Limited ABN AFSL (CMLA) a wholly owned but non-guaranteed subsidiary of the Commonwealth Bank of Australia ABN

49 B Personal statement and confirmation of requirements (continued) 2 I confirm the details of my current cover with the former fund or individual insurer are as follows: a Life cover Date cover started b Total and Permanent Disablement (TPD) cover Date cover started $ $ Please note that you must transfer the total current cover, and you cannot transfer TPD cover without Life Cover, and if the Insurer accepts your application, your amount of cover with the former fund or individual insurer will be matched by an equivalent level of fixed insurance cover, rounded up to the next $1,000. c Income protection cover Date cover started $ Income protection waiting period eg. 30 days, 60 days or 90 days (if your current waiting period is greater than 90 days you are not eligible to transfer your cover) Income protection benefit period eg. two years, five years, to age 65 year benefit period. If your transfer application is for a five year benefit payment period, a two year benefit period will apply 3 Are you restricted, due to injury or illness, from carrying out the identifiable duties of your current and normal occupation on a full-time basis (even if you are not currently working on a full-time basis)? Full-time basis is considered to be at least 30 hours per week even though you may not actually be currently working that number of hours. 4 Have you been paid, or are you eligible to be paid, or have you lodged a claim for a Total and Permanent Disablement or disability benefit from the Plan, another superannuation fund or under a life insurance policy? 5 Have you been diagnosed with an illness that reduces your life expectancy to less than twelve months from today? If you have ticked to Question 3, 4 or 5 you are not eligible for insurance transfer into the Plan. 6 Is your cover with the former fund or individual insurer subject to any premium loadings and/or exclusions, including but not limited to pre-existing condition exclusions, or restrictions in regards to medical or other conditions? If please provide details of the premium loading, exclusion or restriction, including a copy of the advice you received from the former fund or individual insurer advising you of the acceptance of that cover subject to these additional terms. 7 a Do you wish to apply indexation (CPI) to your transferred level of Life only, or Life and TPD cover? b Do you wish to apply indexation (CPI) to your transferred income protection cover? C Occupation risk rating 1 Are the duties of your occupation limited to Professional, Managerial, Administrative, Clerical, Secretarial or similar white collar tasks which do not involve manual work and are undertaken entirely (or at least 80%) within an office environment (excluding travel time to and from one office environment to another)? 2 Are you earning in excess of $80,000 per annum for this profession? 3 Are the duties of your occupation limited to the supervision of manual workers (with no hands on involvement in manual work), site inspections or a sales representative with at least 80% of your time spent in the office? 4 Are you in a skilled occupation with a light amount of manual work (less than 20%)? 5 Does your occupation involve any of the following: driving in excess of 800 kilometres from base, flying other than as a fare paying passenger, working at heights over 15 metres, working offshore or in the mining or oil and gas industries, working on production lines or performing unskilled factory work, scuba diving or handling explosives or weapons? Page 2 of 3

50 D Acknowledgments I acknowledge that: if I do not fully complete, sign and date this application, I will not be eligible to transfer my existing cover to the Plan; and if the Insurer has accepted my application, my cover will commence in the Plan on the date this application is completed subject to cancellation of my existing cover as outlined in Part B; and CommInsure may undertake appropriate enquiry and investigation to verify the answers I have provided on this form; and I agree to provide CommInsure with any authority that may be necessary to access to the health evidence I provided to my former fund, the former fund s insurer or my individual insurer for the purposes of assessing any application for that cover, and I agree that any failure to abide by my duty of disclosure to the former fund, former fund s insurer or individual insurer may be acted upon by CommInsure in respect of cover transferred on the basis of this application; and should it become apparent to CommInsure 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 CommInsure may be reduced in whole or in part 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 the Plan is no less than I would have been eligible to receive under the terms of the policy between the Plan and CommInsure had I not applied for a transfer of cover. Your Duty of Disclosure Before you enter into or become insured under a contract of life insurance with an insurer, 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 insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate your insurance. 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; or as to which compliance with your duty is waived by the insurer. n-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 your 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 has not voided your cover may, within three years of issuing it, elect 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. Full name Member s signature Date Please return the completed form, with attachments, to CommInsure Group Risk, PO Box 321, Silverwater NSW 2128 If you have any questions or require assistance, please call Page 3 of 3