Insurance Opt-in Form

This form is for members:

who join First Super on or after 1 April 2020
are under age 25 and/or have an account balance below $6,000; and
who wish to elect (opt in) to have the default cover of 4 units of Death (including Terminal Illness) and Total and Permanent Disablement (TPD) insurance.

You should read the important information about insurance in super before making a decision. See our Insurance in super booklet or request one to be sent to you from our Member Services Team on 1300 360 988 or mail@firstsuper.com.au.

"*" indicates required fields

SECTION 1: YOUR PERSONAL DETAILS

Title*

Member number

First name*

Middle name

Surname*

Address*

Suburb*

State*

Postcode*

Date of birth*

Contact Number*

Phone number*

Email address

Confirm email address

SECTION 2: Your insurance election?

Completing and signing this form counts as a “Valid Election” under the definition required by current superannuation legislation* and as detailed on page 19 of our Insurance booklet.

Please tick whichever of the boxes apply*

I elect (opt in) to hold and keep insurance cover with First Super even if though I am under age 25 and/or my account balance is below $6,000.

I elect (opt in) to keep any insurance cover held on my behalf with First Super, even if my account balance does not receive a contribution or rollover over a period of 16 continuous months.

SECTION 3: Declaration

I understand that this election (opt-in) will apply to all insurance cover through my account, including any cover for Death (including Terminal Illness), Total and Permanent Disablement, and Income Protection.
I understand the effect insurance premium deductions may have on my account balance.
I understand my election will continue to apply to my insurance cover unless and until it is withdrawn by me by contacting First Super. I understand that I can withdraw my election at any time.
I also understand that I can, at any future time, decrease or cancel my insurance cover by contacting First Super.

Please tick box*

Please tick box

Today's date: 21/11/2024

WE’RE HERE TO HELP. SO LET’S TALK.

If you have any questions, please don’t hesitate to call our Member Services Team on 1300 360 988, or email us.

Annual Statements

Insurance Opt-in Form

SECTION 1: YOUR PERSONAL DETAILS

SECTION 2: Your insurance election?

SECTION 3: Declaration

WE’RE HERE TO HELP. SO LET’S TALK.

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