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Hey there!

Please enter the name of your referrer?

Has your partner already made an appointment?

If so, please enter the appointment code that was provided to join their session.

Are you male or female ?

Please enter your date of birth

Are you a smoker?

Please answer “No” if you have quit smoking (including e-Cigarettes) for at least 12 months

What state do you live in?

What is your line of work?

What is your annual salary?


What is your total amount of debt to clear?

This amount should include the total of your mortgages, personal and car loans, credit card debt etc. that you would wish to clear in the event of your Death or Disablement. By having all your debts repaid you leave your partner or estate in a position of more security.


What is your total amount of realisable assets?

These are the total assets you or your family would be able to access and utilise in the case of your Death or Disablement. This would include your Superannuation along with other assets such as Surplus Cash Reserves, Investment Properties and other non essential Assets.


What is your total amount of replacement income required?

Is someone currently relying on your income? If you die or become disabled, would the loss of this income impact on their lifestyle? If you’re not currently working would your partner stop work and need to replace their income? Insert how much income would be required to cover this replacement income each year to maintain your lifestyle.


What is your total amount of children education debt?

This will include items such as future school costs, special needs, University costs, sporting costs, medical costs, their 1st car, etc. If you don't have children, or if this is not relevant to your situation, please put "0" here.


Is there anything else we should know ?

Other items not covered above. For example, the family may relocate closer to remaining family on your death or disablement and the potential costs involved for this, or ongoing support costs for a disabled child.


What type of cover are you interested in?

Please see your approximate levels of cover required below and estimated premiums and quailty ratings based on a selection of major insurers.

You are able to change this level of cover below to recalculate estimated premiums prior to your meeting with your adviser.
*premium differences may change depending on whether single or multiple covers are purchased

The calculated sums insured are an approximate of the insurance cover required.
The premiums reflected in the table are estimated monthly costs.
The premiums are indicative costs only, and may differ upon application.
The levels of cover provided do not constitute financial advice as we have not taken your entire situation into account,
and have been provided as a guide only prior to your meeting with your financial adviser.

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What date and time this week is most suitable?

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