Hooper Insurance

Purpose

The information collected in this form is solely for the purpose of providing general information on available insurance options. Any quotes, recommendations, or details provided based on this form constitute general advice only and do not consider your personal financial situation, objectives, or needs.

The information you provide in this form will allow us to provide you with a minimum of three quotes. If you are uncertain about disclosing specific information, we recommend disclosing it to ensure your understanding of all options.

Please be aware that not disclosing relevant information may impact your ability to make a claim under an insurance policy.

Hooper Insurance is authorised to provide general advice only and does not offer personalised financial advice. You should carefully review the Product Disclosure Statement (PDS) for each product and consider whether the insurance options discussed suit your circumstances. We encourage you to seek independent financial advice tailored to your specific needs before making any insurance decisions.

What Personal Insurance Products do you require a quote for?

Life InsuranceTotal Permeant Disability (TPD)Trauma Cover (Critical Illness)Income Protection

Amount of Life Cover

Amount of Total Permanent Disability (TPD) Cover

Amount of Critical Illness Cover

What monthly amount would you like to consider for income protection coverage?

Preferred Wait Period

30 days60 days90 days2 years

Preferred Benefit Period

1 year2 years5 yearsTo age 65

How would you prefer to pay for your insurance premiums?

Directly from my bank accountThrough my Superannuation fundI’d like to see both options

Name

PrefixFirst NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Biological gender

Date of birth

Date

Days

Personal Insurance Quote Builder

Personal Details

INCOME

Health and Lifestyle Activities

Dependents less than 18 years of age