Forms.

Use this form for applicants up to age 16. Life cover is available from age 10, up to a maximum of $250,000. Stand-alone Trauma cover is available from birth, up to a maximum of $250,000. This application must be attached to the adult risk application.

Use this form for applicants applying for Child's future insurability option.

Use this form if your customer would like to exercise the Special events, Business events or Future insurability benefit.

Use this form for any risk application.

Use this form if the customer is required to complete a declaration of good health.

Use this form if the applicant is applying for a Mortgage protector policy. If the applicants age is from 16-50 then the maximum amount of cover that this form can be used for is $500,000 for lump sum cover and/or $4,000 monthly benefit. If the applicants age is from 51-59 then the maximum amount of cover that this form can be used for is $150,000 for lump sum cover and/or $1,500 monthly benefit. If the applicant falls outside of these criteria then a full application form must be used.

Use this form if the applicant meets the following conditions: Applicant is aged 16 (age attained) to age 59. The maximum Life cover sum insured for use of this application form is $1,000,000. The total sum insured across all covers cannot be greater than $1,000,000. This can be made up of up to $1,000,000 Life cover or up to $750,000 stand-alone Trauma/Critical illness, Trauma multi or stand alone/ accelerated TPD. For TPD class 2 occupations applying for ‘Own’ occupation TPD, please also complete section 12a. to q. of the full risk application form. Waiver of premium cover may also be included for cases where the total monthly premium does not exceed $1,000 (otherwise a full application form will be required). Please attach an illustration to this application detailing the covers and sum insured being applied for and a direct debit form if appropriate.

Use this form if your customer would like to exercise the Special event additional cover benefit under their Life cover policy.

Use this form for ongoing accepted Income protection type claims where a Power of attorney is involved.

Use this form if your customer needs to provide consent for Fidelity Life to collect additional personal information to assess a claim.

Use this form if your client needs to provide consent for Fidelity Life to disclose personal information to a 3rd party to assess a claim.

Use this form for ongoing accepted Income Protection type claims.

Use this form for ongoing accepted Income Protection type claims.

Use this form where the only claim to be made is for the Hospitalisation Benefit.

Use this declaration if you are applying for risk and health cover.

Use this declaration if you are applying for risk cover only.

Use this direct debit for all Platinum Plus, Platinum Plus Level Term, Mortgage Protector and Funeral Fund policies.

Use this form if the customer(s) wants to cancel their Fidelity Life policy.

Use this form if an insured person or policy owner's name has changed and they want their policy/s to reflect their new name.

Important: If the customer's signing the form electronically, they'll need to make sure both their old and new signature are available to be applied to the form separately.

Use this form if the customer would like to change their investment portfolio.

Use this form if the policy owner(s) would like to change the ownership of their policy.

Use this form to add nominated beneficiaries to the policy. If nominating more than 3 beneficiaries, please complete a second form and attach it to this form. Only Life cover can be assigned through this form.

Please complete this form if the insured person is now a non-smoker and would like the premiums to reflect this change.

Use this form to identify any changes to a policy.

Use this form if a customer would like to reinstate their cover after the policy has lapsed or been cancelled.

This form is used by the policy owner(s) to transfer the rights to the benefit payment to the transferee(s) for an existing policy. A separate form must be completed for each insured person where a transfer of payment rights is requested. All policy owners must complete and sign this form. The policy owner(s), the insured person and transferee(s) should each take a copy of this signed document to complete their records.

This form is used by the policy owner(s) to withdraw all existing transfer of rights/transfer of payment rights on the policy. All policy owner(s) must sign this form. The policy owner(s), insured person and transferee(s) should take a copy of this signed form to complete their records.

Use this form if the Underwriter requests a medical examination with a GP as part of the underwriting assessment.

Use this form if the Underwriter requests a blood test as part of the underwriting assessment.

Use this form if the customer is required to complete a declaration of good health.

View the latest underwriting non-medical limits.

View the latest underwriting guide.

Use this form to complete a direct debit authority for the customers nib policy.