Income Protection

First Name *

Last Name *

Occupation*

State *

Are you an AMA member?*

Yes No

Date of Graduation (if applicable for new professionals cover) *

Date of Birth *

Gender *

Australian Resident *

Smoker/Non Smoker *

Phone *

Email

Pre Existing Medical Conditions?

Medical History?

Employed/Self Employed

If not Full Time – How many hours?

Gross Annual Income

Waiting Period

Benefit Period

Stepped / Level Premiums

Is Needlestick Cover important?

Benefit period – is the time/length of your claim period. This can generally be up to age 65.
Waiting period – is how long you intend to wait after you have been diagnosed with an illness/injury and are unable to work, before you start claiming. This can generally be up to 30 days.
Stepped premiums rise with age, level premiums increase in a more consistent manner as the age based increase is apportioned over the life of the policy.