Thankyou for considering an APS Benefits Group membership. This application will take approximately 10 minutes to complete.

To be eligible for membership you must:

Be an Australian citizen or permanent resident
Provide your identification documents with your full name, date of birth and address (e.g. Driver's Licence, Passport)

All members are automatically entitled to receive a funeral benefit issued by APS Benefits Group Ltd.

A funeral benefit is paid upon your death to a nominated beneficiary. The funeral benefit is included in the cost of membership.

Learn about membership fees and how much funeral benefit you will receive in the Product Disclosure Statement.

You should consider whether the funeral benefit is appropriate for you before deciding whether to become a member of the APS Benefits Group Ltd.

Need help becoming a member?
If you have any questions 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 the Privacy Policy..All members will receive communications via email. At any stage, members can opt-out of email communications by contacting APS Benefits Group on 1300 131 809 or emailing info@apsbenefitsgroup.com.au

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

Personal Information

Is this application on behalf of your dependant child aged between 2 and 25 years old? *

YesNo

Please note: A child member is not eligible to apply for a loan with APS Benefits Group.

Child's Personal Details

Title *

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

Surname *

Date of Birth *You must be aged between 0 and 84 to apply for membership 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.

Please select YES to the question "Is this application on behalf of a dependant child?" before continuing.

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 *

Applicant Personal Details

You have indicated you are applying on behalf of a dependant child. Please provide your details below.

Are you a current member with APS Benefits Group? *

YesNo

Member Number *

Relationship to Child *

Relationship *

Title

Given Name(s) *

Surname *

Date of Birth *

Mobile Phone Number *

Email Address *

Residential Address *

Street address *Street address line 2

City *

State *

Postcode *

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

YesNo

Postal Address *

Postal Address *Postal address line 2

City *

State *

Postcode *

Employment Details

Employer Name

AGS/Employee Number

Occupation/Rank/Position

Identification Documents

Type of Document 1 *

Driver Licence Number *

State Issued *

Card Number *

Licence Expiry *

Australian Passport Number *

Medicare Card Number *

Medicare Card Expiry *

Your card reference *The Medicare reference number is the number next to your name on your card

Type of Document 2 *

You have already chosen that document - please choose another identification document.

Drivers Licence Number *

State Issued *

Card Number *

Licence Expiry *

Australian Passport Number *

Medicare Card Number *

Medicare Card Expiry *

Your card Reference *The Medicare reference number is the number next to your name on your card

Child Identification Document

How much funeral benefit do you require? *Amount must be in multiples of $1000. Minimum funeral benefit is $1000. Maximum funeral benefit is $20,000.

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

Total Funeral Benefit Requested

Starting funeral benefit cannot exceeed $20,000

Payment Information

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 funeral benefit by PAYROLL DEDUCTION.

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

Funeral Benefit Payment Frequency *

FortnightlyQuarterlyAnnually

Funeral Benefit Payment Frequency *

QuarterlyAnnually

Fortnightly cost of dependant child benefit

Annual cost of dependant child benefit

Fortnightly cost of standard funeral benefit

Quarterly cost of standard funeral benefit

Annual cost of standard funeral benefit

Fortnightly additional cover cost

Quarterly cost of Additional Cover

Annual cost of additional cover

Per 1000 cost of additional cover lump sum

Lump sum annual amount for 66yo

Total funeral benefit cost (once off payment)

Annual Cost of Additional Cover per $1000

Age next birthday

Total amount payable FORTNIGHTLY

Total amount payable QUARTERLY

Total amount payable ANNUALLY

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

If the information you have provided is found to be incorrect an APS Benefits Group team member will contact you with your new funeral benefit and payment amounts.

Your account details

Type of Account *

BSB Number *

Account Number *

Account Name *

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 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.

Amount to be charged

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 to arrange for the amount to be paid(as specified in this Membership Application Form) 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 Membership application attached.

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

Account Holder Signature *

Clear

Joint Account holder signature *

Clear

Declarations and Agreements

I wish to apply for membership of the APS Benefits Group Ltd Funeral Benefit. I confirm that the information completed is true and correct. I understand that the APS Group Benefits Ltd 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 PDS/FSG.

I consent to receiving direct marketing communications about APS Benefits Group products and services (optional)

I/we consent for APS Benefits Group to provide me/us with access to APS Online with 2 factor authentification

Applicant signature *

Clear

Where did you hear about us? *

What is their name?We pay $50 for referrals.