Signature and declaration

By ticking this box you declare that you understand and agree to the following statements:
Please provide me additional insurance as set out in this application.

• I acknowledge that my application for top-up cover applies to a policy that is a “group” policy, as Resolution Life provide insurance cover on the life of more than one person, known as a “person insured”.
• I acknowledge this top-up cover relates to additional cover I, as a person insured, am entitled to under the policy.
• I acknowledge the policy does not and is not intended to confer any benefit(s) on or create any obligation enforceable by any person not a party to the policy including without limitation any person insured.
• I declare the truth, accuracy and completeness of all statements given in support of this application for top-up cover (whether in this application, given orally or in any other document in connection with this application) which shall form the basis of any top-up cover resulting from this application.
• I acknowledge that no top-up cover is provided until I receive confirmation that top-up cover has commenced.
• I am actively ‘At Work’ at the date of application. ‘At Work’, in relation to a person, and as at any given date, is defined as:
  a) ‘properly performing all of his or her normal and usual duties of paid employment (or would have been had the relevant day not been a public holiday, weekend day or a day of leave other than due to injury or sickness);
  b) not away from work (other than on paid annual leave) for more than 10 working days in the last 90 days preceding the application date’; and
  c) has not received medical advice that due to an existing illness he or she is not expected to live more than 12 months from the application date.
• I authorise Resolution Life (including its agents) to obtain from, and to disclose to, anyone (including the Policy Owner) my personal information to the extent that is reasonably necessary for Resolution Life to administer and service the policy and consider any claim. I agree that a photocopy of this authority shall be sufficient evidence to anyone of my consent to such release of my personal information to Resolution Life (including its agents). If I do not authorise Resolution Life to request and obtain such information, Resolution Life may be unable to, administer or service the policy or consider any claim.

Disclosure Statements

Duty of disclosure
Until your application has been accepted and we have communicated our acceptance in writing to you for the additional top-up cover, you have a continuing legal duty to tell Resolution Life everything you know (or ought to know) that is material to the risk to be insured under that top-up cover. This duty applies from the time you complete this application until we have accepted your application by communicating in writing our acceptance of the top-up cover. If you fail to do so, Resolution Life may at its discretion decline a claim, avoid or void your top-up cover from inception, decline to pay any benefits or take other action as specified in the policy.

Privacy Act 1993 acknowledgement

The following relates to the personal information provided in this application (and any accompanying documents and communications) and the personal information that may be held about you by Resolution Life already or in the future.

• The personal information collected will be held securely by Resolution Life and used to evaluate and process the application and to administer and service any product you have with Resolution Life and to consider any claims. If any of the information asked for is not provided this application may be declined or the service may be withdrawn.
• You have the right to ask and see the information Resolution Life holds about you. If you believe the information is wrong you may ask that it be corrected by contacting the Policy Owner.

Insurer financial strength rating
Resolution Life Life Limited is is the insurer offering insurance under Spark Cover and has an A- financial strength rating given by Standard & Poor's Australia Pty Ltd, an approved rating agency. Financial Strength Ratings may change from time to time. Contact Resolution Life or your Financial Adviser to confirm Resolution Life insurers' current ratings or go to the rating agency website at www.standardandpoors.com.

A summary of the Standard & Poor's Financial Strength Rating Scale is as follows:

The ratings from 'AA' to 'CCC' may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories.