Wealth & Income Protection Form | AMA Financial Planning

Wealth and Income Protection Insurance Form

Personal Details

Are you an AMA member?*

Yes

Name*

FirstName LastName

Phone*

Email*

Date of Birth*

Gender*

Occupation*

Australian Resident*

Date of Graduation (if applicable for new professionals cover)

States*

Smoker/Non Smoker*

Pre Existing Medical Conditions?

Medical History?

Income Protection

Employed/Self Employed

If not Full Time – How many hours?

Gross Annual Income

Waiting Period

Benefit Period

Stepped / Level Premiums

Is Needlestick Cover important?

Wealth Protection

Please choose

Life Cover

Total and Permanent Disability (TPD) Cover

Trauma (Critical Illness) cover

Note the following:

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.

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Wealth and Income Protection Insurance Form

Personal Details

Income Protection

Wealth Protection

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