Insurance Opt-in Form

"*" indicates required fields

SECTION 1: YOUR PERSONAL DETAILS

Title*

First name*

Surname*

Member number

Address*

Date of birth*

Contact Number*

Email address

Confirm email address

SECTION 2: Choose your "valid election"

Opting in to automatic cover or keeping your cover going is called making a "Valid Election". Completing this form counts as a valid election under current superannuation legislation. Read more about this in the Insurance Guide.

Select one that applies to you.*

I elect (opt in) to hold and keep insurance cover with First Super even though I am under age 25 and/or my current balance is below $6,000.

I elect (opt in) to keep any insurance cover I have with First Super, even if my account balance does not receive a contribution or rollover for a period of 16 continuous months.

SECTION 3: Declaration

I understand that this election (opt-in) will apply to all insurance cover through my account, including any cover for Death (including Terminal Illness), Total and Permanent Disablement and Income Protection.
I understand the effect insurance premium deductions may have on my account balance i.e. that my balance may go down.
I understand that if my balance reaches $0, when a further contribution or rollover is made, I will only receive automatic insurance cover of 4 units of Death & TPD, regardless of my level of cover before my account reached $0.
I understand that my election will apply to my insurance cover until I withdraw it, which I can do at any time.
I understand that I can, at any future time, decrease or cancel my insurance cover by contacting First Super.

Please tick box*

Please tick the box to sign your declaration.

Today's date: 05/07/2025