APF PERSONAL ACCIDENT INSURANCE PROGRAM INDIVIDUAL APPLICATION FORM

PLEASE ENSURE YOU HAVE READ AND UNDERSTOOD THE IMPORTANT NOTICES BELOW

Please be aware that any advice offered is General Advice only and has been prepared without taking into consideration your objectives, financial situation or needs. Before deciding to acquire a financial product please consider the Product Disclosure Statement and whether the product is appropriate for your individual situation and needs.

The APF Personal Accident group policy period has a common renewal date of 30 June. The first year will be pro rata of the above premiums, and annual thereafter at the policy renewal. 

Please note, all members of the APF who apply for this cover will be automatically accepted under either option.

* The death benefit and capital benefit may not be $75,000 in all circumstances. These benefits are limited to a policy aggregate limit of $1,000,000 any one conveyance. This is the maximum payable under the policy for all claims arising from a single event resulting from a parachuting aircraft accident. 

Overview of this insurance 

This insurance policy is intended to provide a personal accident benefit to individual members of the APF who undertake Parachuting activities under the auspices and rules of the APF. 

This insurance policy provides for the payment of lump sums or weekly benefits if you suffer from a bodily injury that results in an insured event listed in the ‘Benefits payable’ section of the Product Disclosure Statement. 

The amount of cover for an insured event will be stated in the schedule ATC issue to you. 

Non-Medicare medical expenses are also included however are only payable as a result of a bodily injury arising from Parachuting. 

The level of cover under this benefit is stated in the schedule.

Significant features and benefits of the cover 

The following is a summary only of some of the key features available under the policy. Please refer to the terms, conditions and exclusions in the Product Disclosure Statement for full details of the cover. 

Section A: 

Accidental Death : ATC will pay a benefit equal to the amount specified in the schedule in the event of you having an accidentwhen covered by the policy which results in your death within 12 months of the accident. 

Section B: 

Capital Benefits : ATC will pay up to the benefit specified in the schedule in the event of you having an accident when covered by the policy which results in permanent disablement within 12 months of the accident. 

Section C: 

Loss of Income : ATC will pay a weekly benefit equal to the amount specified in the schedule in the event of you having an accident when covered by the policy which results in temporary total or partial disablement within 12 months of the accident.

Section D: 

Non-Medicare Medical Expenses : ATC will pay up to the amount specified in the Schedule in the event of you having an accident as a result of parachuting which results in certain non-Medicare medical expenses being incurred.

Before You take out an insurance policy with Us, the Insurance Contracts Act 1984 (Cth) requires You to tell Us every matter that is known to You that: 

• You know to be a matter relevant to Our decision whether to accept the risk and, if so, on what terms, or

• a reasonable person in the circumstances could be expected to know to be a matter relevant to Our decision. Therefore, before You enter (or renew, extend, vary or reinstate) an insurance policy with Us, You must:

• give Us complete and honest answers

• tell Us everything You know, and

• tell Us everything that a reasonable person in the circumstances could be expected to know.

Who needs to disclose? 

You are answering questions on behalf of anyone You want to be covered by this insurance. The duty of disclosure applies to You and everyone else insured by the Policy. 

How long does the duty of disclosure last?

The duty to disclose continues right up to the commencement date or renewal date of the insurance. 

What We do not need to be told 

You do not need to tell Us about any matter that: 

• diminishes Our risk

• is of common knowledge

• We know or, in the ordinary course of business, ought to know or

• We say We do not need to know. 

Failure to disclose 

We can reduce the amount We pay under this insurance for a claim or even cancel the insurance cover if You, or anyone else insured under the Policy, fail to comply with the duty of disclosure. If a non-disclosure is fraudulent, We may avoid the Policy under the Insurance Contracts Act 1984 (Cth), resulting in Us treating the Policy as if it never existed. 

Under insurance 

This means that if You under insure, You may be required to bear a portion of the loss. 

Inadequate space to answer

If there is inadequate space to answer any questions or You need to disclose something to Us because of Your duty of disclosure, please attach a separate piece of paper to this proposal form providing full details.

In this statement “we”, “us” and “our” means Lloyd’s and ATC Insurance Solutions (ATC) as its agent. 

We are bound by the requirements of the Privacy Act 1988 (Cth), the Privacy Amendment (Private Sector) Act 2000 (Cth) and the Privacy Amendment (Enhancing Privacy Protection) Act 2012. This sets out standards on the collection, use, disclosure and handling of personal information. 

Our Privacy Policy is available at www.atcis.com.au or by calling us on the number below. 

We, and our agents, need to collect, use and disclose your personal information in order to consider your application for insurance and to provide the cover you have chosen, administer the insurance and assess any claim. You can choose not to provide us with some of the details or all of your personal information, but this may affect our ability to provide the cover, administer the insurance or assess a claim. 

We may disclose your personal information to third parties (and/or collect additional personal information about you from them) who assist us in providing the above services and some of these are likely to be overseas recipients in the United Kingdom. 

These parties which include our related entities, distributors, agents, insurers, claims investigators, assessors, lawyers, medical practitioners and health workers, and federal or state regulatory authorities, including Medicare Australia and Centrelink will only use the personal information for the purposes we provided it to them for (unless otherwise required by law). 

Information will be obtained from individuals directly where possible and practicable to do so. Sometimes it may be collected indirectly (e.g. from your representatives or co-insureds). If you provide information for another person you represent to us that: 

• you have the authority from them to do so and it is as if they provided it to us;

• you have made them aware that you will or may provide their personal information to us, the types of third parties we may provide it to, the relevant purposes we and the third parties we disclose it to will use it for, and how they can access it.

• If it is sensitive information we rely on you to have obtained their consent on these matters. If you have not done or will not do either of these things, you must tell us before you provide the relevant information. 

You are entitled to access your information and request correction if required. You may also opt out of receiving materials sent by us by contacting ATC on (03) 9258 1700 or write to us at the address given on page 1.

I/We represent that the above statements and facts are true and that no material facts have been suppressed or misstated. Furthermore, I/We:

Click here to view a copy of the Australian Parachute Federation Members Personal Accident Program - Product Disclosure Statement and Policy Wording