AIA Health Insurance
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Appointment Date:
Preferred contact time:
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7:00am
8:00am
9:00am
10:00am
11:00am
12:00am
1:00pm
2:00pm
3:00pm
4:00pm
5:00pm
We will attempt to schedule your appointment as close to your nominated time as possible.
Client Details
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Cover Type
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Single
Couple
Family
State
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New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
West Australia
Age
Current Health Insurer
Do you currently have an AIA Priority Protection policy?
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Yes
No
Currently under review
Additional Notes:
By providing your name and contact details, you consent to your personal information being provided to AIA Financial Services and being contacted to discuss health insurance provided by AIA Health Insurance and other products distributed by AIA Financial Services. Once provided to AIA Financial Services, your personal information will be handled in accordance with the AIA Australia Group Privacy Policy, which can be found at www.aia.com.au along with AIA Financial Services' contact details. Where you obtain health insurance as a result of these discussions, I may be eligible to receive a referral fee from AIA Health Insurance. By ticking this box, I confirm that I have read the consent acknowledgement above and that the customer has confirmed their acceptance.
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