WEDDING INSURANCE APPLICATION FORM

Please arrange to protect our wedding arrangements.

Prior to completing this application form you will need to know which package applies to your wedding (refer Premium Packages.) We also recommend you read  through the Product Disclosure Statement and Financial Service Guide to ensure  this product and our services meet your needs. If you change your mind and cancel you policy within 21 days we will give you a full refund.


Insured/s information
Brides name:* Date of birth :*
Grooms name: Date of birth:
Address line 1:* Town/City:*
Address line 2:

Country:
    Postcode:*
Contact details
Telephone number:* Email address:*
Mobile number: Best contact method:
Fax number: Best contact time:
Referred by: Membership details:
Wedding details
Which Wedding Protection Package best suits you wedding?:
Cover effective from: Wedding Date:
NOTE: if the period of insurance is greater than 12 months an additional premium may apply.
Ceremony Address
Location Name Location  Address
Reception venue
Venue name: Venue address:
Claims history
Has any insurer ever declined to insure you or declined to renew your Policy or asked that you agree to special terms or conditions?:
If yes, please provide details:

Financial service guide

Our Financial Services Guide (FSG) is provided to you on our website. Please consider it before using our services. You can obtain a hard copy of the FSG from Mojomo.

Product disclosure statement

Before using our services or purchasing our Mojomo Wedding Insurance Policy we must provide you with a Product Disclosure Statement (PDS).   The PDS provides you with a summary of the Policy.   The Policy wording explains in detail the insurance you are considering and will assist you to make an informed decision about the Policy.   We do not want you to be disappointed when you wish to make a claim, so it is important you understand the provisions.   As an example, our Policy does not cover a change of heart.   You should also be aware that an excess applies to each Policy section.   An excess is an amount the insurer deducts from a claim made under the Policy.

You may obtain a copy of the PDS by choosing one of the following options:
Off this website, by email – info@mojomo.com.au; by post – call Mojomo on 1800 24 33 12.

Privacy

Privacy legislation regulates the way private sector organisation can collect, use, keep secure and disclose personal information.   Mojomo has developed a privacy policy which explains what sort of personal information we hold about you and what we do with it.  You can obtain a copy of the Mojomo Privacy information from our website under Important Information or direct from Mojomo.

Duty of disclosure

What you must tell us
When answering our questions, you must be honest and you have a duty under law to tell us anything known to you and which a reasonable person in the circumstances would include in answer to the question.   We will use the answers in deciding whether to insure you and on what terms.

Who needs to tell us
It is important that you understand you are answering our questions in this way for yourself and anyone else whom you want to be covered by the Policy.

Non-disclosure
If you do not tell us – If you do not answer our questions in this way, we may reduce or refuse to pay a claim or cancel the Policy.  If you answer our questions fraudulently, we may refuse to pay a claim and treat the Policy as never having worked.

Inadequate space

If there is inadequate space to answer our General Information or other questions or you need to disclose something to us because of your Duty of Disclosure, please use the space below, or alternative send a separate email, giving full details of any additional information

Important information
  1. I/WE acknowledge that a Financial Services Guide and Product Disclosure Statement has been made available to me/us before applying for this insurance.
  2. I/We declare that the Duty of Disclosure and Inadequate Space notices set out above have been read and understood by me/us.
  3. All answers and statements made in this application are true and accurate in every respect and no information has been withheld which is likely to affect your decision about accepting this insurance.
  4. I acknowledge you reserve the right to decline any application.

I have read and understand the declaration and authorisation.

Complete form

 
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