Get Delegated Authority Form

Filling out the Delegated Authority Form online allows you to authorize a representative to act on your behalf regarding your membership with Australian Unity. This guide will walk you through the steps required to complete the form accurately and efficiently.

Follow the steps to fill out the Delegated Authority Form online

1. Click ‘Get Form’ button to access the Delegated Authority Form and open it for editing.
2. In the first section, enter your membership details. Provide your membership number, title (Mr, Mrs, Ms, Miss, Dr), surname, date of birth, first name, and residential address (avoiding PO Box). Make sure to include your suburb, state, and postcode.
3. Next, in the nominated representative details section, fill in the representative's information. Select their title, input their surname, date of birth, first name, and residential address (not a PO Box). Include their suburb, state, postcode, home phone number, mobile number, and email address.
4. In the authorisation section, confirm that you authorize Australian Unity to release your membership details and relevant personal information to your nominated representative. You can also indicate if you want to grant them additional authority to suspend or cancel your membership or change the level of your cover.
5. Once you have filled out all required fields, remember to provide your signature and the date to validate your authorisation.
6. After completing the form, you have the option to save your changes, download the document, print it for physical submission, or share it electronically.

Complete your Delegated Authority Form online today to ensure your representative can assist you promptly.