PLAYER INSURANCE BROCHURE 2016
|
|
|
- Sandra Lindsey
- 10 years ago
- Views:
Transcription
1 PLAYER INSURANCE BROCHURE 2016
2 INSURANCE INFORMATION This plan has been arranged by the Australian Rugby Union on behalf of all Insured persons. WHO CAN MAKE A CLAIM? A claim can be made by any person who is a registered player, coach, trainer, manager, administrator, voluntary worker, selector, referee, touch judge or ball boy of a club that is part of the Australian Rugby Union Limited who has been injured whilst playing or engaging in Rugby Union, training for, or travelling to and from a club match or administrative or social activity. WHAT BENEFITS AM I ENTITLED TO? CAPITAL BENEFITS Death $100,000 or, if under 18 years, $20,000. Quadriplegia or Paraplegia $400,000. Other Permanent Disability (as per table) up to $300,000. NON MEDICARE MEDICAL EXPENSES (EXCLUDING MEDICARE GAP ) Payment of 100% of non-medicare medical expenses (incurred within 12 months of injury) after any reimbursement from your health fund. These expenses include private hospital accommodation, physiotherapy, pharmacy, ambulance and dentistry. They do not include Doctor, Surgeon, Specialist or Anaesthetist fees (including the Medicare Gap). The maximum benefit payable is $3,000. An Excess of $100 applies to each claim (No excess for Ambulance only claims) The National Health Act does not permit the Insurer to contribute to any Medical Expenses covered (whether fully or partly) by Medicare ( the Medicare Gap ). All medical treatment must be certified necessary by a medical practitioner. This insurance does not take into consideration the individual needs of insured persons and does not seek to replace the need for Private Medical Insurance and/or Life Insurance. The ARU recommends that ALL players consider individual coverage as required for their own circumstances.
3 WHAT BENEFITS AM I ENTITLED TO? (CONT) WEEKLY BENEFITS Weekly Benefits are payable as below whilst you are temporarily totally disabled and wholly and continuously prevented from engaging in any occupation and/or attending school and/or studies. Income Earners - 100% of gross income (net of business expenses) up to a maximum of $300 per week for 52 weeks. 28 day excess applies. Non Income Earners - 100% of authorised domestic help up to a maximum of $300 per week for 52 weeks. 14 day excess applies. Full Time Students - 100% of authorised tutorial costs up to a maximum of $300 per week for 52 weeks. 14 day excess applies. Parents Inconvenience Expenses - Reimbursement of expenses incurred by parents in visiting an insured full time student aged under 25 years hospitalised through injury up to a maximum of $100 per day. Maximum benefit is $2,000 (2 day excess). TRAVEL AND ACCOMMODATION EXPENSES Reimbursement of Travel and Accommodation Expenses, in regard to - the injured person - expenses incurred in travelling to hospital or a place of treatment where the travel is in excess of 100 kms emergency attendance on the injured person by the Injured person s family members which results in the need for overnight accommodation in either a registered hotel or motel. Limited to 80% of the actual Travel and Accommodation Expenses, with Accommodation Expenses not exceeding $150 per night. Subject to a maximum of $1,000 in total. FUNERAL BENEFIT Funeral expenses following death caused by accident or illness whilst participating in rugby activities. The maximum Benefit is $5,000. PUBLIC/PRODUCTS LIABILITY & PROFESSIONAL INDEMNITY Legal liability up to $20,000,000 (Professional Indemnity $10,000,000). Excess $1,000 each and every loss.
4 HOW DO I MAKE A CLAIM? When making a claim for an injury, you must: 1. Advise your Club Secretary that you wish to make a claim. 2. Obtain from your Club Secretary: Sports Injury Claim Form to be completed by you, and Attending Physician s Statement to be completed by your doctor. 3. Send both fully completed forms to: Cunningham Lindsey Australia Pty Ltd PO Box 1438, Parramatta NSW 2124 Phone: Claims must be advised as above within 30 days of injury. 5. When completing the claim form, ensure that you provide as much information as possible. This may include documents, records or even photographs for identification. 6. You must attend any medical examinations or other assessment organised by QBE Insurance or Cunningham Lindsey Australia Pty Ltd. 7. You must take all reasonable steps to recover from any injuries. 8. If you require an update on the status of your claim, you may contact Cunningham Lindsey Australia Pty Ltd as above or phone WHO CAN I TALK TO ABOUT AN ISSUE OR COMPLAINT? 1. Talk to QBE Insurance staff first, ask for accident and health underwriting or claims staff. 2. If the matter cannot be resolved, it will be referred to QBE s Internal Dispute Resolution (IDR) representative. 3. If the matter cannot be resolved internally, QBE will provide you with details of the Financial Ombudsman Service (FOS) - an independent external dispute resolution body.
5 BROKER TO THE SCHEME Gow-Gates has been established over 40 years and is one of the largest Australian owned Insurance Brokers. For information in respect of the following products please contact Gow-Gates Insurance Brokers on or Group Travel Insurance - Property Insurance - Top Up Insurance - Income Protection Insurance Gow-Gates Insurance Brokers Pty Ltd - ABN AFSL Level Kent Street, Sydney NSW GPO Box 4731 Sydney NSW 2001 Phone: (02) , [email protected] DUTY OF CARE STATEMENT When you register and play with a Rugby Union Club, you are reminded that Rugby Union is a body contact sport. Potential, notwithstanding all safety guards, exists for a player to sustain injury. Players must therefore prepare themselves for the game by having a commitment to training and a high level of fitness. As a measure of your club and your Union s support to players and officials, the ARU has arranged insurance cover as set out in this document and for your benefit and risk protection. In addition to these policies all players and officials may, and are encouraged, to take out private health insurance, life insurance and Top Up cover over and above the Insurance cover specifications defined in this brochure, particularly in relation to Loss of Income. For any advice or additional insurance cover that any member of your club or association may require please contact Gow-Gates Insurance Brokers Pty Limited. This plan is underwritten by QBE Insurance (Australia) Ltd - ABN Level 5, 2 Park Street, Sydney NSW 2000
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: ANA042769PAD Claim Number: BICYCLE QUEENSLAND PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR BICYCLE QUEENSLAND; V-Insurance Group Pty Ltd Authorised Representative No.
"#$ % & &% $ & 3 0456 $&& 77-1014 #( 81 9:55 5;55 '3( 81 9:55 ;;10 ' ) *#! $# ##+$!, #( "#$ % & $%&!#'#( $ ) $!"( * " # + >*& % $ '$2 #!!"! ##?
!!"!#!!$!! "#$ % & $%&!#'#( $ ) $!"( *#! $# ##+$!, #( '( ' ) * & *+!+# # #+!#!($!+ -!!.( /01 2 /34%!!(!! # ) +! #!!( *!+ 5!! -( * $ # " $ #! " + 2!6 7 6 6 6 ##6 # +!! + +!! $#!## " #,!!.,- ) * " 5!! -#
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: ATCSI00035 Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR TABLE TENNIS AUSTRALIA V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: AN A043307 PAD Claim Number: ATHLETICS AUSTRALIA PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR ATHLETICS AUSTRALIA V-Insurance Group Pty Ltd Authorised Representative No.
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: 0028332 Claim Number: s PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR TENPIN BOWLING AUSTRALIA V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised
SPORTS INJURY CLAIM FORM NSW JUNIOR RUGBY LEAGUE
SPORTS INJURY CLAIM FORM NSW JUNIOR RUGBY LEAGUE This information must be completed and signed by the Injured Person, a Club Official and your District Administrator and forwarded to Cunningham Lindsey
PERSONAL INJURY CLAIM FORM
Willis Australia Limited ABN: 90 000 321 237 AFS License Number 240600 Office use only Policy Number: SUA/002395 Claim Number:. TABLE TENNIS AUSTRALIA PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR TABLE
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: AN A038364 PAD Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR TRIATHLON AUSTRALIA V-Insurance Group Pty Ltd Level 28, Angel Place, 123 Pitt Street, SYDNEY
PERSONAL INJURY INSURANCE CLAIM FORM 2012/2013. Basketball WA
PERSONAL INJURY INSURANCE CLAIM FORM 2012/2013 Basketball WA 1 Dear Basketball Member, Please find attached a claim form. Before lodging this form, please ensure all sections are fully completed. Failure
NSW Junior Rugby League
NSW Junior Rugby League Club Administrators Sports Insurance Manual 2011 Prepared By Gow-Gates Insurance Brokers (Australasia) Pty Ltd (A.B.N. 29 069 562 787 ~ AFSL: 245433) Index Subject: Page No: Introduction
JUDO FEDERATION OF AUSTRALIA
Office use only Policy Number: ANA043293PAD Claim Number: JUDO FEDERATION OF AUSTRALIA PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR : V-Insurance Group Pty Ltd Authorised Representative No. 432898 an
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: Claim Number: 01PO527349 PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised representative of Willis
MELBOURNE NETBALL PERSONAL INJURY CLAIM FORM
Willis Australia Limited ABN: 90 000 321 237 AFS License Number 240600 Office use only Policy Number:.SUA/002646 Claim Number:. MELBOURNE NETBALL PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR MELBOURNE
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: 34568 Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR BASEBALL AUSTRALIA; V-Insurance Group Pty Ltd Authorised Representative No. 432898 a corporate authorised
How To Get A Netball Insurance Policy In Netball V Victoria
Office use only Policy Number: SUA/003700 Claim Number:. PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR NETBALL VICTORIA V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised representative
MOUNTAIN BIKE AUSTRALIA
Office use only Policy Number: ATCSI00039 Claim Number: MOUNTAIN BIKE AUSTRALIA PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR MOUNTAIN BIKE AUSTRALIA INC; V-Insurance Group Pty Ltd Authorised Representative
PERSONAL INJURY CLAIM FORM
Willis Australia Limited ABN: 90 000 321 237 AFS License Number 240600 Office use only Claim Number:. ATHLETICS AUSTRALIA PERSONAL INJURY CLAIM FORM Willis Australia Limited HEAD OFFICE Level 8, 2 Market
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: SUA/002202 Claim Number: Willis Australia Limited ABN 90 000 321 237 AFS 240600 PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR TRIATHLON AUSTRALIA Willis Australia Limited
PERSONAL INJURY CLAIM FORM
V-INSURANCE GROUP Corporate Authorised Representative of Willis Office use only Policy Number: 0028785 Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR ATHLETICS AUSTRALIA V-Insurance Group
PERSONAL INJURY CLAIM FORM
V-INSURANCE GROUP Corporate Authorised Representative of Willis Office use only Policy Number: CYCL01STI-1112 Claim Number: PEDAL POWER ACT PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR PEDAL POWER ACT;
AUSTRALIAN BASEBALL FEDERATION
V-INSURANCE GROUP Corporate Authorised Representative of Willis Office use only Policy Number: SUA/002395 Claim Number:. PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR THE ; V-Insurance Group Pty Ltd
PERSONAL INJURY CLAIM FORM
Willis Australia Limited ABN 90 000 321 237 AFS 240600 Office use only Policy Number: SUA/003700 Claim Number:. PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR NETBALL VICTORIA Willis Australia Limited
PETANQUE FEDERATION AUSTRALIA LTD
Willis Australia Limited ABN: 90 000 321 237 AFS License Number 240600 Office use only Claim Number:. PETANQUE FEDERATION AUSTRALIA LTD PERSONAL INJURY CLAIM FORM Willis Australia Limited HEAD OFFICE Level
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: ATHL01STI-LY0411 Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR ATHLETICS AUSTRALIA V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised
Sports Injury Claim Form
Sports Underwriting Australia Sports Underwriting Australia Claims Department PO E: [email protected] Box 2717, Taren Point. NSW, 2229 Tel: Ph: 1300 363 363 413 413 Fax: +61 2 9524
PERSONAL INJURY CLAIM FORM
Office use only Policy Number: Claim Number:. PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR BASKETBALL VICTORIA V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised representative
Sports Injury Claim Form
Sports Underwriting Australia Sports Injury Claim Form Sports Underwriting Australia Claims Department PO Box 2717, Taren Point. NSW, 2229 Tel: 1300 363 413 Fax: 02 9524 9003 Email: [email protected]
PERSONAL INJURY CLAIM FORM
Willis Australia Limited ABN: 90 000 321 237 AFS License Number 240600 Office use only Claim Number:. PETANQUE AUSTRALIA PERSONAL INJURY CLAIM FORM Willis Australia Limited HEAD OFFICE Level 5, 179 Elizabeth
Financial Services Guide
Financial Services Guide Issued: 1 November 2013 In this Financial Services Guide (FSG), we, our, us or AEGON means AEGON Direct & Affinity Marketing Services Australia Pty Ltd (ABN 35 082 524 785) with
PERSONAL INJURY INSURANCE CLAIM FORM FOR
PERSONAL INJURY INSURANCE CLAIM FORM FOR Please ensure all sections are fully completed prior to submitting your claim. Failure to complete all sections of this form may delay settlement of your claim.
JLT SPORT. How To Make A Claim. Public Liability, Professional Indemnity and Associations Liability Claims
How To Make A Claim JLT SPORT Public Liability, Professional Indemnity and Associations Liability Claims It is essential that you notify JLT Sport immediately of any potential claim. It is also extremely
QBE INSURANCE (AUSTRALIA) LIMITED ABN 78 003 191 035
GROUP PERSONAL ACCIDENT POLICY SCHEDULE Policy Number: Policy Wording: The Insured: The Business: AN A042331 PAD QBE QM 360-0312 Sports Injury Insurance Policy Wording (as attached) Cycling Australia Inc.,
Certificate of Currency Our Ref: 076719. Surf Life Saving Western Australia, including clubs, branches and/or affiliated entities.
24 October 2014 Jardine Lloyd Thompson Pty Ltd ABN 69 009 098 864 27 Evelyn Street NEWSTEAD QLD 4006 PO Box 2321 Fortitude Valley BC QLD 4006 Tel +61 7 3246 7555 Fax +61 7 3246 7590 www.jlta.com.au Certificate
SECTION ONE: POLICY AND PERSONAL INFORMATION - ALL QUESTIONS REQUIRE COMPLETION. Name of Insured Company
Sydney Level 4, 33 York Street Sydney NSW 2000 GPO Box 4213, Sydney, NSW, 2001 T: +61 2 9251 8700 F: +61 2 9252 4385 ABN: 26 053 335 952 AFS Licence : 238621 Email: [email protected] www.acchealth.com.au
Community Underwriting Personal Accident Claim Form
Community Underwriting Personal Accident Claim Form About Community Underwriting Community Underwriting Agency Pty Ltd (Community Underwriting) acts under a binding authority as Agent for Berkley Insurance
Your People, Protected. Sports group Personal Accident Claim Form
Your People, Protected Sports group Personal Accident Claim Form Sports group Personal Accident/Claim Form 2 Claim Form Dear Member, IMPORTANT INFORMATION, relevant to YOUR Claim, is contained on this
SECTION ONE: POLICY AND PERSONAL INFORMATION - ALL QUESTIONS REQUIRE COMPLETION. Name of Insured Company
Sydney Level 4, 33 York Street Sydney NSW 2000 GPO Box 4213, Sydney, NSW, 2001 T: +61 2 9251 8700 F: +61 2 9252 4385 ABN: 26 053 335 952 AFS Licence : 238621 Email: [email protected] www.acchealth.com.au
Principally promoters, organisers and operators of Mini Trotting events including all associated activities.
Personal Accident INSURED BENEFICIARIES BUSINESS GEOGRAPHICAL SCOPE PERIOD OF INSURANCE SCOPE OF COVER Voluntary Workers of Mini Trotting Clubs and Associations as detailed below including all members,
SECTION ONE: POLICY AND PERSONAL INFORMATION - ALL QUESTIONS REQUIRE COMPLETION. Name of Insured Company
Sydney Level 4, 33 York Street Sydney NSW 2000 GPO Box 4213, Sydney, NSW, 2001 T: +61 2 9251 8700 F: +61 2 9252 4385 ABN: 26 053 335 952 AFS Licence : 238621 Email: [email protected] www.acchealth.com.au
Worldwide Sports Insurance - A Guide to Compensation
Worldwide Sports Insurance ABN 30 129 444 828 AFS Lic No: 342385 WWSI is a Business Unit of PSC Horsell Insurance Brokers Pty Ltd Level 12 P O Box N661 Tel: (02) 9247 1700 189 Kent Street Grosvenor Place
WILLIS ED GROUP STUDENT PERSONAL ACCIDENT CLAIM PROCEDURE FOR PARENTS
WILLIS ED GROUP STUDENT PERSONAL ACCIDENT CLAIM PROCEDURE FOR PARENTS Student Accident Claims are managed by the insurer AIG Australia Limited (formerly Chartis) Completed claim forms and supporting documentation
Your Financial Services and Credit Guide
Your Financial Services and Credit Guide Version 8 Date: 01/07/2014 Table of contents www. THE DOCUMENTS YOU WILL RECEIVE FROM US - 3 - ABOUT OUR LICENSEE - 4 - ABOUT US - 5 - HOW WE MANAGE YOUR PERSONAL
SPORTING ACCIDENT CLAIM FORM Please read this page first before completing the Claim Form
SPORTING ACCIDENT CLAIM FORM Please read this page first before completing the Claim Form Dear Member, Thank you for your Claim Form request. This letter contains important information relevant to your
PERSONAL ACCIDENT CLAIM FORM - MEMBERS
Pony Club Insurance Scheme PERSONAL ACCIDENT CLAIM FORM - MEMBERS Please read this page before completing the Claim Form Dear Member Thank you for your Claim Form request. This letter contains important
HEALTH LEGISLATION FROM PAYING ANY MEDICARE SERVICE INCLUDING THE MEDICARE GAP
ABN 76 000 005 210 AFSL No. 235415 GPO Box 180 Melbourne 3001 Telephone 1300 138 498 Facsimile 03 9934 3468 [email protected] www.ccinsurances.com.au SchoolCare Claim Form Important
CLAIM FORM: AMATEUR SPORTS PERSONAL ACCIDENT INSURANCE THE ISSUE OF THIS FORM IS NOT AN ADMISSION OF LIABILITY PLEASE ENSURE
CLAIM FORM: AMATEUR SPORTS PERSONAL ACCIDENT INSURANCE THE ISSUE OF THIS FORM IS NOT AN ADMISSION OF LIABILITY PLEASE ENSURE You fully complete every question before your doctor completes his statement.
Run-Off Cover Scheme (ROCS) Important Information Effective from 1 October 2014
Run-Off Cover Scheme (ROCS) Important Information Effective from 1 October 2014 MDA National Insurance Pty Ltd ABN 56 058 271 417 AFS Licence No.238073 Introduction Section 1: Terms and Conditions of
JLT Sport Personal Injury Claim Form
Football NSW Risk Protection Programme Who should use this claim form? You should complete this form if: Insured - You are a player, umpire, official or volunteer (Insured Person) of a League/Club (the
Catholic Church Insurance Limited will act on your claim as soon as we receive this form. You can help us to act quickly for you by:
Personal Accident Claim Form Claim Number (office use only) How to Get Quick Action on Your Claim Catholic Church Insurance Limited will act on your claim as soon as we receive this form. You can help
OAMPS Sports Risk Management
2012/13 OAMPS Sports Risk Management Sports Injury Insurance Cover Closer to clients Closer to Communities Sports Injury Insurance Cover We are pleased to present this quick guide to the 2013/2014 Sponsorworx
Personal Accident. Schedule of Benefits
Personal Accident INSURED Harness Racing Australia Inc (HRA) and it s Members (State Controlling Bodies excluding Harness Racing New South Wales), Australian Mini Trotting Clubs (as below), Junior Member
IMPORTANT INFORMATION: PLEASE READ CAREFULLY
BASKETBALL PERSONAL INJURY CLAIM FORM IMPORTANT INFORMATION: PLEASE READ CAREFULLY Dear Basketball member, Please find attached a claim form. Before lodging this form, please ensure all sections are fully
SLE WORLDWIDE AUSTRALIA PTY LIMITED A.B.N. 15 066 698 575 AFSL 237 268
GROUP PERSONAL INJURY POLICY THE SCHEDULE OF COMPENSATION Policy Number 221054401003 Insured Insured Person(s) Country Rugby League of NSW Inc. All registered players; officials; accredited coaches; accredited
Private Plus Hospital - $250/$500 Excess & Basic Extras Effective 1 September 2014
Mail: Locked Bag 25, Wollongong NSW 2500 - Phone: 1800 148 626 - Fax: 1300 673 406 Email: [email protected] - Web: www.onemedifund.com.au Private Plus Hospital - $250/$500 Excess & Basic Extras Effective
JLT Sport Personal Injury Claim Form
Who should use this claim form? You should complete this form if: Insured - You are a player, umpire, official or volunteer (Insured Person) of an Association/Club (the Insured) covered within the ; and
Accident & Health International Underwriting Pty Ltd STUDENT INJURY POLICY. Product Disclosure Statement (PDS) and Wording
Accident & Health International Underwriting Pty Ltd STUDENT INJURY POLICY Product Disclosure Statement (PDS) and Wording FEDERATION OF PARENTS & CITIZENS ASSOCIATION OF NSW STUDENT INJURY INSURANCE This
Personal Accident & Sickness Claim Form IMPORTANT NOTES
Personal Accident & Sickness Claim Form IMPORTANT NOTES PRIVACY STATEMENT In this Privacy section we, us or our means Great Lakes Australia and Winsure, unless specified otherwise. CONTACT US We are committed
Claim Number. Departure Date: From / / To / / Occupation Date of Birth / / Date of Booking Travel Arrangements Date of Departure Date of Return
Savannah Insurance Agency Pty Ltd ABN 84 130 364 313 Corporate Travel Claim Form Details of the Insured Insured Name (Traveller) Policy Number Claim Number IMPORTANT 1. Please complete the Policy Details
Builders Warranty Claim Form
Builders Warranty Claim Form IMPORTANT NOTICES About the Insurer This insurance is underwritten by Great Lakes Reinsurance (UK) SE (ARBN 127 740 532, ABN 18 964 580 576, AFSL 318603) trading as Great Lakes
Personal Accident Claim Form
Corporate Services Network ABN 30 074 864 609 Level 2 280 George Street Sydney NSW 2000 Ph: 61 2 8256 1770 Fax: 61 2 8256 1775 www.csnet.com.au e-mail: [email protected] Personal Accident Claim Form
PERSONAL ACCIDENT INSURANCE CLAIM FORM AND PROCEDURE
PERSONAL ACCIDENT INSURANCE CLAIM FORM AND PROCEDURE In order that your claim may be dealt with as quickly as possible, please ensure that you tick that you have addressed all of the items below.. If you
JLT Sport Personal Injury Claim Form
Who should use this claim form? You should complete this form if: Insured - You are a player, umpire, official or volunteer (Insured Person) of a League/Club (the Insured) covered within the AFL National
Australian Trainers Association Group Personal Accident Insurance Claim Form
ACE Insurance Limited ABN 23 001 642 020 28-34 O Connell Street Sydney NSW 2000 Australia GPO Box 4065 Sydney NSW 2001 Australia (02) 9335 3355 main (02) 9231 3697 fax www.aceinsurance.com.au A&[email protected]
This form must be accompanied by an Attending Physicians Statement, which can be obtained by telephoning any of our offices listed.
This form must be accompanied by an Attending Physicians Statement, which can be obtained by telephoning any of our offices listed. Full ne of Policyholder Policy Number To be completed by Policyholder
Cash Back Cover We ve got you covered for life.
Cash Back Cover We ve got you covered for life. Contents Combined Product Disclosure Statement and Financial Services Guide Page No. Product Disclosure Statement 3 About Cash Back Cover 3 Information about
