Welcome
The purpose of completing an insurance pre-assessment is to provide us with some information on your health or lifestyle related details that may affect your application for insurance. We appreciate this information is personal and sensitive in nature, but we do this to work with our insurers to obtain the very best outcome possible for you.
Please enter your name
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First Name
Last Name
On what basis are you working?
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Full-Time
Permanent Part-time
Fixed Term Contract
Casual
Unemployed
Retired
Home Duties
What is your current occupation title?
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Please advise the details of any trade, tertiary or professional qualifications you have (if any)?
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How many hours do you work per week?
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Please provide details
Please provide a description of the duties you perform as part of your role, and indicate the percentage of time you spend doing each area
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Please provide details
Your Height
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Your Weight
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How much weight have you lost?
When did you cease smoking?
Please provide details
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What is your estimated date of delivery?
Please provide details
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Please provide any other information about yourself, your health history or families health history that may be relevant to insurance cover.
Please provide details
Have you in the last 12 months, do you currently or do you intend to take part in any of the following activities?
Aviation (other than as a fare paying passenger)
Hang-gliding/hot-air ballooning/parachuting/bungee jumping/sky-diving
Competitive Motor sports (inc car, motorbike and boat etc)
Recreational Motor sports (inc trail motorbike riding etc)
Underwater diving inc scuba and free diving
Football (amateur competition/semi-professional) i.e. AFL, soccer, rugby
Martial Arts/Boxing (fitness only)
Martial Arts/Boxing (competitive)
Horseriding (recreational only)
Horseriding (including competitive/events)
Rock-climbing/Abseiling
Please provide details
Please provide details
Submit
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