PSSapLPC03 08/16Transfer of cover form Important information Use this form if you want to transfer Death only cover, Death and Total and Permanent Disability (TED) cover or Income Protection cover.

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How to fill out the AU PSSapLPC03 online

The AU PSSapLPC03 form is essential for transferring your insurance cover into the PSSap plan. This guide provides step-by-step instructions to help you complete the online application easily and accurately.

Follow the steps to fill out the form correctly.

  1. Press the ‘Get Form’ button to obtain the AU PSSapLPC03 form and open it in the online editor.
  2. Provide your personal details in Section A. Include your PSSap member number, salutation, surname, given names, date of birth, residential and postal addresses, phone numbers, and email address.
  3. In Section B, answer the eligibility questions regarding your current work status, any previous claims, illness, or injury. Be honest and ensure your answers are clear to determine your eligibility for a cover transfer.
  4. In Section C, input details of your existing insurance cover. Specify the name of the previous fund or insurer, your member or policy number, and indicate if the cover is subject to any special conditions. Provide the amounts for death and TPD cover you wish to transfer as well as details for income protection cover if applicable.
  5. In Section D, confirm your agreement to the stated declarations by ticking the appropriate boxes. Review the statements carefully to ensure that you agree with the terms.
  6. Sign and date the declaration section, ensuring the date is entered correctly.
  7. Once completed, save your changes. You can download, print, or share the completed form as needed.

Complete your document online and transfer your insurance cover today.

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