Thank you for considering purchasing additional funeral cover from APS Benefits Group. This application will take about 10mins to complete.

To obtain an additional funeral benefit up to a maximum benefit value of $20,000 (excluding any ex gratia payments), you may pay a lump sum or increase your membership fees. The cover will apply for accidental death in the first 2 years

To be eligible to increase your funeral benefit you must:

Be an Australian citizen or permanent resident

Learn about additional funeral cover fees and how much funeral benefit you can apply for in the Funeral Benefit Cover and Additional Cover tables and read the product disclosure statement and financial services guide here .

You should consider whether the funeral benefit is appropriate for you before deciding whether to increase your funeral cover with APS Benefits Group Ltd.

Need help increasing your funeral benefit
If you have question about this application, please contact us on 1300 131 809

Important Information

Important information on how we collect and secure your personal information can be found in Privacy Policy

By completing this application you acknowledge that you have received and read the Combined Financial Services Guide and Product Disclosure Statement.

Personal Information

Member Number *

Title *

Given Name(s) *You must include all legal middle name(s)

Surname *

Date of Birth *You must be aged between 16 and 84 to apply for additional funeral benefit with APS Benefits Group

Mobile Phone Number *

Alternate Phone Number

You have input a date of birth that indicates this application is for a dependant child aged 16 or under next birthday.

Additional cover is not available for dependant children.

Email address *

Residential Address (PO Box not accepted) *

Street address *Street address line 2

City *

State *

Postcode *

Is your postal address the same as your residential address? *

YesNo

Postal Address *

Street address *Street address line 2

City *

State *

Postcode *

Beneficiary Details

In the event of your death, you funeral benefit will be paid to the following person. This information can be updated at any time.

Would you like to update or change your current beneficiary? *

YesNo

How Many beneficiaries would you like to nominate? *

Beneficiary 1

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 2

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 3

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 4

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 5

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 6

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 7

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 8

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 9

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Beneficiary 10

Given Name(s) *

Surname *

Beneficiary Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

Phone Number

Email Address

Your Funeral Benefit

How much additional funeral benefit do you require? *Amount must be in mulitples of $1000

How much additional funeral benefit do you require? *The additional funeral benefit must be a multiple of $1,000

Additional Cover Payment

How will you be paying for your funeral benefit? *

Direct debit from bank accountDirect debit from credit cardPayroll Deduction (Government departments only)

How would you like to pay for your funeral benefit? *

Direct debit from bank accountDirect debit from credit card

You have chosen to pay your additional funeral benefit by PAYROLL DEDUCTION.

Please contact your payroll office and arrange for your deduction to begin to APS Benefits Group Ltd.

Will you be paying for your additional cover in instalments or as a once off lump sum? *

FortnightlyQuarterlyAnnuallyOnce-off lump sum

Additional Cover CC frequency *

QuarterlyAnnuallyOnce-off lump sum

The amount shown below is in addition to your current funeral benefit cost (if applicable)

Annual cost of additional cover

Fortnightly cost of additional funeral benefit

Fortnightly Cost of Additional Cover

Quarterly cost of Additional Cover

Total cost of additional cover (once-off payment)

Per 1000 cost of additional cover lump sum

Lump sum annual amount for 66yo

Total additional funeral benefit cost (once off payment)

Annual Cost of Additional Cover per $1000

Age next birthday

All amounts shown are approxiumate values based on the information you have provided in your application.

A member of the APS Benefits Group team will contact your to confirm your total funeral benefit and amount payable.

You have chosen to pay your funeral benefit ANNUALLY

Annual payments are due 1st Julyeach year

A pro-rata amount will be charged to your nominated account with the first full payment occurring 1st of July.

You have chosen to pay your funeral benefit QUARTERLY

Quarterly payments are due 1st January, 1st April, 1st July and 1st October each year

A pro-rata amount will be charged to your nominated account with the first full payment occurring on the next quarterly date.

Please download the APS Benefits Group direct debit request here

Complete, save a copy and send the completed form to membership@apsbenefitsgroup.com.au.

Your account details

Type of account *

BSB Number *

Account Number *

Account Name *

The nominated bank account or credit card must be in the same name/s as the applicant/s. Third party accounts will not be accepted. We may take additional steps to verify the accuracy of any bank account details provided to us.

I/We request and authorise APS Benefits Group Ltd (ABN 64 077 846 809) to arrange for the amount to be paid to be debited from my/our account at the financial institution identified above through the Bulk Electronic Clearing System and paid to APS Benefits Ltd in relation to I/my additional funeral benefit application attached.

I/We have read and agreed to the Direct Debit Terms and Conditions between me/us and APS Benefits Group Ltd *

Account Holder Signature *

Clear

Joint account holder signature *

Clear

Declarations and Agreements

I wish to apply for additional cover of the APS Benefits Group (APS) Funeral Benefit. I confirm that the information completed is true and correct. I understand that the APS Funeral Benefit has not considered my financial situation, needs and objectives and my decision to apply for this cover is based on my understanding of the information I have received and read, including the Combined Financial Service Guide and Product Disclosure Statement (FSG/PDS). I understand that the cover will only be provided in the first 24 months in the event of accident death only. I agree that any personal information can be collected, used and disclosed as prescribed in the FSG/PDS.

Applicant signature *

Clear