TEST – AIL of New Zealand

Request - PSA

Name*
First Last
PSA Membership Number:
Contact Number*
Street Address*
City*
Suburb*
Postcode*
Best time to call
Email*
Please tick the benefit(s) that you are wanting more information about below:
- Free Benefit: Certificate of Coverage - Free Accidental Death & Dismemberment Cover ($1,500 for member, $500 for spouse and each child under 19 years)
- Optional Extra Benefit: Accidental Death Benefit – ($10,000 for $2 first year and renewable each year after for $5)
- Additional Accidental Death and Dismemberment Cover
- Accident Injury Cover (including sports injuries)
- Hospital Indemnity
- Cancer Protection
- Critical Illness Cover
- Life Insurance – Permanent or Term Life Cover
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