Member Election Form - For Inactive Accounts

Insurance election to continue insurance coverage if your account becomes inactive

Under section 68AAA of the Superannuation Industry (Supervision) Act 1993 (Cth), your insurance in your super account with BUSSQ will be cancelled if:

your account has been inactive for a continuous period of 16 months; and
you have not elected to continue your insurance.

Completing this online form will let BUSSQ know that you want your insurance cover to continue even if your super account becomes inactive for a continuous period of 16 months.

If you do not wish to make this election, you do not need to complete this form. If you do not make the election:

your insurance cover held will end if your super account is inactive for a continuous period of 16 months; and
should you wish to re-instate or re-apply for insurance cover in the future, you may be required to provide appropriate medical evidence to enable the insurer to decide whether to accept cover and on what terms.

To make the election, please tick the box and complete your details below:

I elect under section 68AAA of the Superannuation Industry (Supervision) Act 1993 (Cth) for all and any insurance in my super account to be continued even if my super account becomes inactive for a continuous period of 16 months.

Your Details

To help BUSSQ identify you, please complete the information below. Note that fields marked with an * asterisk are mandatory.

Member Number*

Email*

Title*

Mr Mrs Ms Miss Dr Other

First name*

Surname*

Date of Birth*

Gender*

Male

Female

Occupation*

RESIDENTIAL ADDRESS

Address Line 1*

Address Line 2

Suburb/Town*

Country*

Postal/Zip Code*

Questions?

Please contact BUSSQ on 1800 MY BUSSQ (1800 692 877) should you have any questions in regards to the insurance in your BUSSQ super account or if you want to make changes to that insurance.

Consent

I consent to the collection, use, storage and disclosure of my personal information (including health and other sensitive information) as described in Zurich’s Privacy Policy which is available at https://www.zurich.com.au/important-information/privacy.html .