PAS Personal Accident and Sickness Insurance (Income Protection) Step 1 of 7 - Policy Pre Registration - Step 1 0% Policy StatusPolicy IDAccess CodeBroker CodeBroker NameBroker WebsiteBroker CompanyBroker Email Cerberos FSG Use Cerberos FSG AR Broker Yes No Policy Created ByUserBrokerThank you for choosing to apply online. Please complete the details below to get started. The process is quick and easy and will only take a few minutes.When do you want this insurance to start?* Date Format: DD slash MM slash YYYY Policy Finish Date - Policy Finish Date Date Format: DD slash MM slash YYYY Finish date plus one year Date Format: DD slash MM slash YYYY How did you hear about us?*ReferralWeb SearchAdvertOtherCAPTCHAThis site uses cookies to track your progress through the application process. As part of EU law we must get your permission to store cookies on your computer. View our cookies policy HERE (opens in new tab) Consent* I consent to storing cookies General Advice Warning - This information may be regarded as general advice. That is, your personal objectives, needs or financial situations were not taken into account when preparing this information. Accordingly, you should consider the appropriateness of any general advice we have given you, having regard to your own objectives, financial situation and needs before acting on it. Where the information relates to a particular financial product, you should obtain and consider the relevant product disclosure statement before making any decision to purchase that financial product. You can view our policy wordings here: Self Employed 24 hours a day Employee Outside Working Hrs Only Employee inc Workers Comp Top Up Your policy start date - Please fill in the required fieldsFirst Name*Surname*PhoneMobile Phone*Street*Suburb*State*Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaPostcode*Weekly Sum Insured*3004005006007008009001000110012001300140015001600170018001900200021002200230024002500Please note you can only cover yourself for up to 85% of your gross incomeGross IncomeEmail* Height (cm)*Please enter a number from 100 to 230.Birth Date* Date Format: DD slash MM slash YYYY Weight (kg)* You must be aged between 16 - 65 to apply for this insurance If your BMI is above 30 or below 16, your policy quote will be sent for reviewAgeAge GroupAccident Load Price: $ 0.00 Quantity: Accident Load - NewSickness Load Price: $ 0.00 Quantity: Sickness Load - NewGender*MaleFemaleOccupation*--Please Select an Occupation---Other-AbattoirAccountant (Non Turf)Actor/ ActressActuaryAcupuncturistAdministration StaffAdvertising AgentAdvertising Installer/ Bill PosterAerial Installation (As small part of Group cover, eg TV rental firm)Aerial Installation (Only activity)Agricultural Contractor (Excl. use of explosives)Agricultural Contractor (Incl. Explosives)Air Traffic ControllerAircrew (Cabin Crew)Aircrew (Engineer (excl. flight-work))Aircrew (Engineer (incl. flight-work))Ambulance crewAnalyst (Clerical only)Antique Dealer (Incl. repair or restoration)Antique Dealer (Sales only)ArbitrationArborist/Tree LopperArchitect (Excl. site work)Architect (Incl. site work)Armed ForcesAromatherapistArt Dealer (Incl. repair or restoration)Art Dealer (Sales only)Artist (Commercial)Artist (Other)Asphalter/ RoadworkerAssembly WorkerAssessorAthleteAuctioneerAuditorAuthorBacteriologistBaggage HandlerBailiffBaker (Delivery & Baking)Baker (Shop only)Ballet DancerBank (Cashier, Clerk, other clerical)Bank (Security)Bar StaffBarberBarristerBasket MakerBeauticianBee KeeperBetting shop/BookmakerBicycle Dealer & repairBiologistBlacksmithBoat Builder (Other)Boat Builder (Wood & Glassfibre only (excl. use of power-driven wood-working machinery & excl. boating))BoilermakerBook KeeperBookmakerBooksellerBotanistBottlerBouncerBoxerBrewery (Brewery Worker excl Delivery)Brewery (Brewery Worker Incl Delivery)Brewery (Clerical only)BricklayerBrickmakerBroadcaster- TV & RadioBroker (Commodity)Broker (Insurance)Broker (Livestock)Broker (Loan or Pawn)Broker (Oil)Broker (Stock)Builder & Contractor (Over 3 stories)Builder & Contractor (Up to 3 stories)Building Consultant- Excl Manual WorkBuilding InspectorBus (Conductor)Bus (Driver)Business ConsultantButcher (Excl. slaughtering)Butcher (Incl. slaughtering)Buyer (Merchandise clerical)Buyer (Merchandise incl. other duties)Cabinet Maker (Excl. woodworking machinery)Cabinet Maker (Incl. woodworking machinery)Cafe ProprietorCameramanCamping/Caravan Site OperatorCare AssistantCareers Advisory ServiceCaretakerCarpenter, Joiner, Shop Fitter (Excl. the use of power-driven woodworking machinery)Carpenter, Joiner, Shop Fitter (Incl. the use of power-driven woodworking machinery)Carpet FitterCashierCatering Staff (Excl. cooking)Catering Staff (Incl. cooking)Cattle Breeder / DealerCavity Wall insulatorCement or Brick WorksChauffeurChefChemical Works (Hazardous products (explosive, corrosive, toxic, inflammable))Chemical Works (Non-hazardous products)Chemist (Consulting)Chemist (Laboratory or Analytical)Chemist (Pharmaceutical)Chief Executive Officer (Clerical only)ChiropodistChiropractorChurch / ClergyCinema StaffCircusCivil Engineering (Clerical incl. site visits)Civil Engineering (Clerical only)Civil Engineering (Manual)Civil Engineering (Site work superintending)Claims/Loss AdjusterCleaner (Industrial & external incl. windows - Over 2 stories)Cleaner (Industrial & external incl. windows - Up to 2 stories)Cleaner (Offices, shops, houses (internal))ClergymanClerical ServicesClerkClerk of WorksClothing (incl. footwear) (Maker, Shrinker, Waterproofer)Clothing (incl. footwear) (Merchant)Club/ Hotel ManagerCoach DriverCoal & Coke Suppliers (Excl. delivery)Coal & Coke Suppliers (Incl. delivery)Commercial TravellerCompany Director (Clerical only)Company Search AgentsComposer of MusicComputer (Consultant/ ContractorComputer (Engineer)Computer (Programmer / Operator)Confectionery MakerConference OrganiserConstruction material supplerCookCopywritersCorporate Identity ConsultantsCourier Driver- MotorcycleCourier Driver-VansCrane Operator / ErectorCrop Spraying (Excl. aerial work)Crop Spraying (Incl. aerial work)CuratorCustoms OfficerCycle Dispatch RiderDairymanDancerDancing InstructorDemolitionDentistDesignerDesktop PublishingDetective (Police)Detective (Private)Detective (Store)Dietician/NutritionistDiverDock ConstructionDock LabourerDoctor (GP)Doctor (Psychiatric)Doctor (Surgeon or Anaesthetist)Dog Breeder or TrainerDoorman (Excl. security)Doorman (Incl. security)Double Glazing (Installer)Double Glazing (Salesman)Drainage Contactor (Domestic)Drainage Contactor (Industrial)DraughtsmanDredging ContractorDressmakerDriver (Bus & Coach)Driver (Car Delivery Driver)Driver (Courier)Driver (HGV Driver)Driver (Light Goods)Driver (Taxi )Driver (Train)Driver (Truck)Driver (Van)Driving Examiner or instructorDry Cleaner/LaunderetteEditorEditorial ConsultantsEducation Advisory ServicesElectrical EngineeringElectrician (Commercial)Electrician (Domestic)EmbalmerEnergy ConsultancyEngineering (Heavy (castings, machine tools), no installation)Engineering (Heavy with installation)Engineering (Light (electronics, small domestic appliances))Engineering (Medium (large dmoestic appliances))Engineering (Office Based)EngraverEntertainerEvent PlannerExcavator DriverExplosives UserExport ConsultantsFactory WorkerFarm AgentFarmer (All other)Farmer (Dairy only or supervising)FarrierFashion DesignerFencing ContractorFilm CameramanFilm MakerFire Service (Group)Fire Service (Individual - full time)Fireworks manufactureFirst Aid TrainerFish (Curer, Monger, Fryer)Fish (Factory excl. cutting & gutting)Fish (Farmer)Fish (Filleter)Fishing (Inshore)Fishing (Sea-fishing)Florist, retail onlyFood Hygiene ConsultancyFood Industry ConsultantsForestry (Incl. tree-felling)Forestry (Tree-felling not a major part of job)Forklift DriverFoundary WorkerFrench PolisherFruiterFuneral Director (Coffin Assembly)Funeral Director (Embalmer)Funeral Director (Non-Embalmer)Fur & Leather GoodsFurniture DealerFurniture MakerFurniture RemovalistFurniture RepairerGame Keeper & WardenGarbage CollectorGardener (Landscaping exc Tree-felling)Gardener (Tree-felling)Gas / Oil installation (Land based)Gas / Oil installation (Offshore - see offshore note)GenealogistsGeologistGlass & PotteryGlazier (Excl. use of scaffolding / craddles)Glazier (Incl. use of scaffolding / craddles)Grain Miller (incl. animal feedstuffs)Graphic DesignerGreengrocerGrocerGunsmithGym Instructor / Fitness TrainerHairdresserHarbour MasterHarbour PilotHealth (Ambulance Crew)Health (Anaesthetist)Health (Ancillary Staff)Health (Clerical only)Health (Doctors (GP's))Health (Midwife)Health (Nurses)Health (Porter)Health (Psychiatric Nurse)Health (Surgeon / Dentist)Health and Safety ConsultancyHeating EngineerHGV DriverHorse Riding Establishment (Instructor (no competitive activities))Horse Riding Establishment (Stable staff only)Horse TrainerHorticulturistHotel (All other work)Hotel (Bar)Hotel (Doorman (excl. security))Hotel (Housekeeper)Hotel (Porter)Hotel (Proprietor - manual)Hotel (Working excl. kitchen)Hotel/Restaurant OwnerHousehold Furnishings & CarpetsHousekeeperHousewife / husbandHovercraft crewHuman Resource ConsultancyIce Cream Sales (Mobile)IllustratorImage ConsultantsInspector (Agricultural)Inspector (Aircraft - ground only)Inspector (Building)Inspector (Bus)Inspector (Clerical)Inspector (Customs)Inspector (Ticket)Instrument MakerInsurance AdjusterInsurance Agent, Underwriter, Broker, ClerkInterior DecoratorInterpreterIronmongerIT ConsultantJewellerJockeyJournalist (Local)Journalist (National)Journalist (Worldwide)JudgeKeep Fit instructorKennel WorkerKennel/ Cattery WorkerKindergarten TeacherKitchen InstallerLaboratory WorkerLabourerLathe OperatorLaundryLawyerLibrarianLife Guard (Coastal)Life Guard (Pool)Lighting ConsultancyLocksmithMagistrateManagement ConsultantsManaging Director (Clerical only)Map Drawers / CartographersMarket Gardener / nurserymanMarket Research ConsultantsMarket TraderMarketing ConsultantsMartial Arts instructorMason (See Stonemason)MasseurMedia Account ManagersMedia Development ManagersMediatorsMerchant Navy (Crew)Merchant Navy (Officers)Metal WorkerMeteorologistMidwifeMilkmanMillerMiner (Above Ground)Miner (Underground)ModelMonumental Mason (See Stonemason)Motor (Manufacturer)Motor (Mechanic)MusicianNannyNews Reporter (Inside or studio only)NewsagentNight WatchmanOccupation Health & Safety ConsultancyOccupational TherapistOffice Worker (Clerical with little or no travel)Office Worker (Clerical with some travel)Office Worker (Clerical with substantial travel)OffshoreOil Rig WorkersOpera SingerOphthalmologistOpticianOptometristOsteopathPaint SprayerPainter (not artist)Painter Commercial (Excl. use of scaffolding / craddles & interior)Painter Commercial (Incl. use of scaffolding / craddles)Panel BeaterPaper/ Carboard ManufacturerPattern MakerPedicurePest ControllerPest Controller FLICKPharmacistPhotographer (Aerial)Photographer (Local Press)Photographer (National Press, Industrial (no aerial or underwater))Photographer (Studio work)PhysiotherapistPilot (Aircraft Passenger/Charter)Pilot (Marine)Pilot (River)Pipe LayingPlant Hiring (With operator)Plant Hiring (Without operator (delivery maintenance only))Plant OperatorPlasterer (Exterior)Plasterer (Interior)PlasticPlumberPolice ForcePorter (Railway, Airport, Hospital etc)PostmanPostmasterPotterPoultry FarmerPrinterPrison OfficerPrivate DetectiveProfessional EntertainerProfessional SportsmanPsychiatrist (excl. Prison / Mental Institution work)Public Relations ConsultantsPublicanPublisher/PublishingQuality Assurance ConsultantsQuarrying, open-cast mining, sand & gravel extraction (Explosives)Quarrying, open-cast mining, sand & gravel extraction (No explosives)Real Estate AgentRelocation AgentsResearch ConsultancyRetail Worker (Incl. installation work - hazardous)Retail Worker (Incl. installation work - non-hazardous)Retail Worker (Premises only plus some manual work (eg cycle dealer, fruiterer, greengrocer etc))Retail Worker (Premises only, no manual work (eg chemist, clothier, confectioner etc))Retail Worker (Premises risk plus hazardous work (eg butcher, fishmonger - excl. slaughtering))Roofing (All other)Roofing (Slates & tiles)Rope Access TechnicianSaw MillScaffolderScrap Metal MerchantSecretarial ServicesSecretarial/Word Processing AgenciesSecurity Service (General Security (no cash handling))Security Service (Store Detective / Internal Security Staff only)Security Service (Van crews)Service Station AttendantService Station Employee (Clerical only)Service Station Employee (Incl. vehicle repair & recovery)Service Station Employee (Mechanic)Service Station Employee (Sales or Petrol Filling Station only)Ship-breaker/Builder/RepairerShoe Maker/ RepairerShopfitterSignwriterSmall Business Advisory ServicesStablehand (Excl. Race Horses)Stablehand (Incl. Race Horses)Steel FixerSteel WorkerStocktakersStructural SteelworkerStudentTaxi DriverTeacherTeachers AidesTextile Bleaching & Dyeing Machine OperatorsTextilesTheatre Staff (Manual (eg scenery maker))Theatre Staff (Non-manual (eg Box-office))Tiler, roofing workTimber Yard (excl. sawmills & tree-felling)Tobacco PrecessorTraffic WardenTraining ConsultantsTraining ServicesTranslators / InterpretersTransport Driver (Bus & Coach Driver)Transport Driver (Bus & Coach Maintenance)Transport Driver (Car Hire Driver)Transport Driver (Ferry crew)Transport Driver (Ferry Maintenance)Transport Driver (Railway Driver / Guard)Transport Driver (Railway Maintenance)Transport Driver (Railway Station Staff)Tunnel WorkerUnderground MinerUndertaker (no use or power-driver wood-working machinery)UpholstererVan DriverVehicle Manufacturer (no testing)Veterinary Surgeon (excl. zoos/wildlife parks)Virtual AssistantsWaitore/WaitressWedding PlannersWelderWharfie/ DockerWig MakerBusiness NameOccupation ClassClass 1Class 2Class 3Class 4ReferAge Modifer Price: $ 0.00 Quantity: Class Modifier - NewOccupation Duties*Has your weight altered by more than 10% in the last 12 months?*YesNoYou have answered Yes to your weight being altered. Please enter more details here.*Are your duties hazardous? (e.g Explosives/dangerous substances, working from heights)*YesNoYou have answered Yes to hazardous duties. Please enter more details here.*Review RequiredDo you currently, or do you intend to engage in any hazardous pursuit or pastime, including but not limited to football of any code, boxing, rodeo activities, wrestling, martial arts, racing of any kind (other than on foot), motorsports, polo, water skiing, scuba diving or underwater activities, parachuting, parasailing, hang gliding, or other aerial activities, ski jumping, snow or ice sports, grass skiing, mountaineering, bungee jumping, abseiling, caving, shooting or training for or participating in professional sport of any kind. If “YES” please provide details.*YesNoYou have answered Yes to the question above. Please enter more details here*Due to some of your answers, your quote will require a review, please complete all questions until the end to enable review consideration.Please select an occupation before continuing. Your policy start date - BMI Cover Type Scope of Cover*Scope of Cover means the operative time of the policy cover i.e. when cover is force.Self employed 24 hours a day, 365 days a yearEmployee, outside working hours only, excluding work related conditionsEmployee, 24 hours a day, 365 days a year including Workers Compensation top upType of Cover (Weekly benefits for income protection)*Injury means bodily injury (including death) resulting solely from an Accident which occurs while this policy is in force.Sickness means illness or disease which first becomes apparent while this policy is in force. Sickness does not include any pre-existing illness or disease or Injury of which You were aware, or for which You have received treatment, or advice for treatment or has been prescribed medication or has consulted a medical practitioner or other health professional, at any time prior. (see policy wording for further detail).InjuryInjury and SicknessElimination period*The 'elimination period' is the time between you becoming unable to work and your policy benefits commencing. Also known as an excess period.– Fill Out Other Fields –Benefit Period*52 Weeks104 WeeksPolicy Wording - Self Employed 24 hours a day / Employee inc Workers Comp Top UpPolicy Wording - Employee Outside Working Hrs OnlyAccident Discount Price: $ 0.00 Quantity: Accident Discount - NewSickness Discount Price: $ 0.00 Quantity: Sickness Discount - NewAccident ModifierSickness ModifierAccident Annual Base PremiumAccident If Statement Price: $ 0.00 Quantity: Accident IF Statement - NewSickness Annual Base PremiumSickness If Statement Price: $ 0.00 Quantity: Sickness If statement - NewAbove Minimum Price: $ 0.00 Quantity: Below Minimum Price: $ 0.00 Quantity: EndorsementsBase premium DiscountedBase Premium finalStamp Duty Modifer Price: $ 0.00 Quantity: AD Class Loading Values Price: $ 0.00 Quantity: AD Class Loading Values - NewCapital Benefits (Death and total permanent disablement by accident only)*Covers Injury (not a Sickness) resulting in any of the events specified in the Capital Benefits Table (including Death, Quadriplegia, Paraplegia and Permanent Total Disablement for lump sum benefits) within twelve months of the Injury as a percentage of the Capital Sum Insured selected (see policy wording for full detail).YesNoCapital Benefit Sum insured*25,00050,00075,000100,000125,000150,000175,000200,000225,000250,000AD Base PremiumAD GSTAD StampPA/PAS Premium TotalAD Caps & PremiumTotal Base PremiumAnnual GSTAnnual StampFeeInc GSTBroker FeeBroker Fee GSTBroker Fee (Inc GST)Total Stamp DutyTotal Annual Premium Price: $ 0.00 Total Annual Premium - Currency Save QuoteDue to some of your answers, your quote will require a review, please complete all questions until the end to enable review consideration. Your policy start date - Is all of your work undertaken within Australia?*YesNoYou have answered "No" to is all your work done in Australia. Please provide details below.*We can only provide cover for people working in AustraliaHas any application for accident or illness insurance on your life ever been declined, modified, accepted at an increased premium, cancelled or refused renewal?*YesNoYou have answered "Yes" regarding having a policy being declined, cancelled, refused renewal etc. Please provide details below.*Have you ever claimed for benefits under any accident or illness policy?*YesNoYou have answered "Yes" to having made a claim. Please provide details below.*Have you ever had abnormal blood pressure, ulcers, diabetes, tuberculosis, cancer, paralysis, arthritis or rheumatism; HIV, AIDS or AIDS related conditions; any disorders of the mental, respiratory, nervous, genile-urinary, digestive or circulatory systems, or the back, spine, eyes or heart; epilepsy or drug and/or alcohol abuse?*YesNoYou have answered "Yes" to having multiple health conditions. Please provide details below.*During the last 5 years, have you suffered from any other health problem or impairment not mentioned above or have you taken prescribed medication of any kind?(It is not necessary to answer “Yes” if only for colds or flu).*YesNoYou have answered "Yes" to having suffered from other health problems not previously mentioned. Please provide details below.*Do you currently have any symptoms of ill health or injury or are you taking prescribed medication of any kind?*YesNoYou have answered "Yes" to currently having symptoms of ill health and taking prescribed medication. Please provide details below.*For the Scope of Cover selected will you be entitled to claim under any other existing or intended insurance from any other source providing for weekly benefits, worker’s compensation, or sick leave?*YesNoYou have answered "Yes" to being able to claim under another insurance company or source. Please provide details below.Is there any likelihood of reoccurrence of any illness or injury previously suffered or the possibility of you undergoing surgery or other treatment?*YesNoYou have answered "Yes" to there being a likelihood of having a reoccurrence of a previous illness or injury. Please provide details below.*Review will be requiredDue to some of your answers, your quote will require a review, please complete all questions until the end to enable review consideration. Save Quote Your policy start date - Your premium based on the provided information 105 Save QuoteDue to some of your answers, your quote will require a review, please complete all questions until the end to enable review consideration.PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM* I have read and understood the IMPORTANT NOTICES AND FINANCIAL SERVICES GUIDE You can view the Important Notices HERE You can view the Financial Services Guide HEREYou can view the Important Notices HERE You can view the Financial Services Guide HEREI/We declare that the statement and particulars in this proposal form are true and that no material facts have been misstated or suppressed after enquiry. I/We agree that should any of the information given by us alter between the date of this proposal and the inception date of the insurance to which this proposal relates, I/We will give immediate notice thereof. I/We agree that the Underwriters may use and disclose our personal information in accordance with the "Privacy Statement" included in the IMPORTANT NOTICES of this Proposal. I/We agree that this proposal, together with any other information supplied by me/us sall form the basis of any contract of insurance affected thereon.Broker Declaration* I confirm that the answers provided by the Insured are true and correct and shall be the basis of this contract. TO BE SIGNED BY THE INSURED FOR WHOM THIS INSURANCE IS INTENDED FOR* ELECTRONIC SIGNATURE ACKNOWLEDGEMENT Date* Date Format: DD slash MM slash YYYY Name* First Last It is important the undersigned of the declaration above is fully aware of the scope of this insurance so that these questions can be answered correctly. If in doubt, please contact the broker or agent, since non-disclosure may affect an insureds right of recovery under the policy* I confirm the start date of my policy Your policy start date - Select payment type*Credit Card - Annual amount in full via credit cardPremium Funding - Monthly amount over 12 equal instalmentsPlease select the relevant payment type to continueSubtotal $ 0.00 Total $ 0.00 Credit Card* MasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Premium Funding Interest ChargePremium Funding Interest RatePremium Funding TotalPremium Funding InstalmentPremium Funding Details Your first instalment is . There are 11 instalments remaining each of . These are payable monthly on the same day of each month. Premium: 105 Interest Charges: Total Amounts Repayable: No Of Instalments: 12 Interest Rate: 8% Initial Instalment: Subsequent Instalments: Premium Funding is currently unavailable but will be added soon. Please select Credit Card to make payment. Bind acknowledgement* I acknowledge that clicking BIND will bind a policy