Prepaid Funeral Application - Afterlife Funerals
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Prepaid Funeral Application
Section 1 Application details
Applicant
Individual
Title
Surname
Gives Names
Date of Birth
/ /
Phone/Mobile
Email
Address
Town/Suburb
State
Postcode
Mailling Address
Town/Suburb
State
Postcode
Section 2 Investment details and payment method
Choose the relevant investment type, insert the amount and choose from one of the four payment options.
Investment type & amount
  • Assigned
    $
  • GST^
    $
  • Admin fee^
    $
  • Total
    $
^Funeral director use these sections only if GST and Admin Fee are include with payment.
Payment type
Direct credit information
BSB:302-162
|
Account No: 1437096
Account Name: Funeral Fund Australia
Please use the APPLICANT SURNAME as the Payment Refrence
Cheque information
Make cheque payable to: Funeral Fund Australia
Post cheque to: PO Box 1033 Hurstville BC NSW 1481
PLEASE ENSURE YOU HAVE TICKED YOUR PAYMENT TYPE.
Section 3 Declaration & Signatures
Before signing this Application form, applicants should read the entire PDS to which this Application relates. By signing this Application form, the applicant(s) acknowledge, declare and agree that:
  • I/we have read the attached PDS and agree to be bound by the terms and conditions of the PDS and the Constitution of the Society. I/we understand that the maturity date of the Bond is the date of death of the applicant or the Life Insured or in the case of joint applicants, the Bond will mature upon the death of either one of the applicants as selected by the surviving applicant and in all cases, subject to completion of the Society's claim procedures;
  • In the event that I/we effect more than one funeral bond or enter into additional bonds, the aggregate contributions do not and will not exceed the amount required to meet the cost of my/our funeral;
  • By providing my/our email address in this Application form, the Society may use this address to provide me/us, where permitted by law or regulation, with information via email about my/our investment and the Australian Funeral Bond, including any communications, such as annual statements to satisfy any continuous disclosure requirements. (To alter the communication method, please contact the Society);
  • As an investor in the Bond, that prior to the Bond maturing, I/we have no right to access the Bond benefits or surrender the proceeds of the Bond;
  • As with any investment contract, there are inherent risks in investing into the Fund and these risks are set out in the PDS;
  • I/we acknowledge that the Society does not guarantee the investment performance of the Fund.
  • I/we consent to provide the Society with personal information and for the Society to collect, use, disclose and store personal information in accordance with the Society's Privacy Policy.
Applicant Signature
Date
/ /
Section 4 Assigning your Bond to a Funeral Director
I/We in accordance with the Life Insurance Act 1995 (Cth) and the Constitution of Society, wish to assign this Bond to:
Assigned to
Name
Phone
SECTION 5
NOTE - An assignment transfers complete ownership to the funeral director. All future notices will be forwarded to the specified funeral director. This assignment is not valid until registered by Society. This assignment is subject to the Bond being issued. Assignors must be at least 16 years.
Direct debit form
Please ensure you complete all required sections using BLOCK LETTERS.
Section 1 Applicant and/or Account Holder information
Applicant or Account Holder
Name
Phone
Address
Email
Suburb
Date
/ /
State
Postcode
Applicant (from funeral bond Application)
Other account holder*
* If the account to be debited is an account of someone other than the funeral bond applicant(s), please provide the account holder information. If it is a company bank account, please complete Account Holder and provide additional information in Section 5. I/we request and authorise the Australian Friendly Society Limited ("the Society") with user ID number 203654 to arrange a debit to my/our nominated account any amount the Society, has deemed payable by me/us. This debit or charge will be arranged by Society's financial institution and made through the Bulk Electronic Clearing System (BECS) from your nominated account and will be subject to the terms and conditions of the Direct Debit Request Service Agreement.
Section 2 Direct debit details
Please choose the frequency in respect to your DDR, provide the payment per frequency, the commencement date (on or after) and total contribution value (the value, excluding bonuses, at which the DDR will cease).
Frequency Fortnightly(thurs) Monthly(15th) Once Off
Amount
$
$
$
Commencement date
/ /
/ /
/ /
Total Contributions
$
$
$
Frequency Fortnightly(thurs)
Amount
$
Commencement date
/ /
Total Contributions
$
Frequency Monthly(15th)
Amount
$
Commencement date
/ /
Total Contributions
$
Frequency Once Off
Amount
$
Commencement date
/ /
Total Contributions
$
Section 3 Your account to be debited
Please completed each section. The account to be debited cannot be a credit or debit card number or account.
Name of Financial Institution
Account Name
Branch No. (BSB)
Account Number
Section 4 Confirmation
By ticking and/or providing us with a valid instruction you confirm that you are authorised to operate the nominated account and you have understood and agree to the terms and conditions set out in this DDR and in your Direct Debit Request Service Agreement.
Section 5 Additional Account Holder Company
By ticking, you are confirming you are authorised to sign on behalf of the company AND you have authority to operate the Company's bank account.
Company Name
Position Held
ABN
Australian Funeral Bond
Issued by Australian Friendly Society Limited