Superannuation/TPD Claim Questionnaire

Compensation - TPD Questionnaire

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Your Details

Your privacy is important to us. This form is hosted on a secure, protected platform. If you prefer not to share certain details online, you're welcome to call us on 1800 621 071 and one of our friendly team members can assist you over the phone.

Name

First

Last

Date of Birth

Address

Phone

Medicare Number

Centrelink Number

Tax File Number

Do you have a superannuation account?

Yes

What is the name of your Super Fund and your Member Number?

Do you know if you hold any life insurance products with an insurer (i.e. income protection, TPD, or a trauma policy?)

Yes

What is the name of the insurer?

Have you already lodged a Super/TPD claim?

Yes

If you are human, leave this field blank.

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