Insurance — Cover reinstatement form

If your cover was cancelled due to inactivity, you can reinstate it by completing this form. Inactivity means your account has not received any contribution or rollover for a continuous period of 16 months.

Reinstatement of cover is subject to certain conditions and these can be found in the Insurance guide (and/or the Insurance transition guide for ex-QIEC Super members).

We must receive this form within 60 days from the date your insurance cover was cancelled.

Complete your personal details

NGS Member number

Title

Given names

Surname

Date of birth

Residential address

Suburb

State

Postcode

Is postal address same as residential address?

Yes No

Postal address

Suburb/Town

State

Postcode

Phone number

Personal email

I confirm that I wish to maintain my insurance cover even when my account is Inactive unless I notify you otherwise in writing, or my cover ceases due to the terms and conditions of the NGS Super insurance policy.

I have read and understood the general advice warning and privacy statement.

Insurance — Cover reinstatement form

Insurance — Cover reinstatement form

Complete your personal details

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