Join Avant

Membership with Avant Mutual Group Limited ABN 58 123 154 898
Intern/RMO1 Indemnity Insurance with Avant Insurance Limited ABN 82 003 707 471 AFSL 238765

Before completing the Acceptance of Offer form please take the time to read the Intern/RMO1 Indemnity Insurance Policy Product Disclosure Document (PDS).

This is an Acceptance of Offer Form for Membership and an Intern/RMO1 Indemnity Insurance Policy and retroactive cover as an Intern/RMO1. This is a legal document, which will form (a) the basis of the contract of insurance between the insured (you) and Avant Insurance Limited (Avant Insurance); and (b) the basis of your contract of Membership with Avant Mutual Group Limited (Avant). When reading this document a reference to 'we', 'our' and 'us' will mean Avant Insurance. 'You' and 'your' will mean the insured.

By submitting this form or otherwise providing your personal information to Avant you consent to your personal information being collected, held, used and disclosed by Avant in accordance with the Avant Privacy Policy found here
http://www.avant.org.au/Privacy-Policy/.

The offer details on this form only apply if you meet the following selection criteria:

1. You must be an Intern/RMO1 who is eligible or has professional registration from the Medical Board of Australia who will be engaged or is engaged in medical training in an Australian hospital.

2. You must only be performing work that is consistent with your category of practice as per the Category of Practice Guide.

3. You must have answered 'no' to all of the questions asked in the claims and history section of this form.

If you fall outside the selection criteria above this Acceptance of Offer Form does not apply to you – you will need to complete a full application form and return it to us so we can consider whether we will make an offer of insurance
If you are unsure about any information to be supplied, please contact Member Services on 1800 128 268

* indicates compulsory fields

Contact Information
 



You will receive the product disclosure statement, renewal documentation, Financial Report and Annual Report electronically. If you wish to receive these by post, please email us at memberservices@avant.org.au
I consent to Avant contacting me in accordance with Avant’s Privacy Policy (including via email and SMS if you have provided your email address and mobile number). I understand that I may alter this consent at any time by contacting Avant.

You will receive the notice of Annual General Meeting and other member communications from Avant electronically to the email address you have nominated. If you wish to receive these by post, please contact us at memberservices@avant.org.au.

Please ensure that you maintain a current email address with us at all times so that we can ensure the successful delivery of communications to you. If you change address, change practice details or move overseas please let us know.
Professional Details
Retroactive cover is automatic to the date you first commenced work as an intern in Australia or the date that you complete this Acceptance of Offer Form (whichever is earliest).
Claims, complaints, incidents or proceedings
If you answer YES to any of the following questions, this offer does not apply – please call 1800 128 268 and ask for an application form:
1. Have you ever had any claims or complaints or has there been an incident which may lead to a claim or complaint in connection with your training or from healthcare provided by you? *
2. Have you ever been counselled or disciplined in relation to alcohol or drugs? *
3. Have you ever been charged with, convicted or found guilty of a criminal offence? *
4. Have you ever made a self notification or been the subject of a voluntary notification to AHPRA? *
Membership and insurance offer
Period Policy Details $Amount
From the date I provide this completed Acceptance of Offer Form to Avant Insurance to 31 December 2024 Avant Membership (inclusive of GST)

Avant Insurance Intern/RMO1 Indemnity Insurance Policy

Category of practice: Intern or RMO1 (per above)
Retroactive cover from: the date first commenced work as intern in Australia or the date that I complete this Acceptance of Offer Form (whichever is earliest). 		$0


$0
As part of this Avant policy you are eligible for FREE Lite Extras Cover* from Doctors’ Health Fund.This exclusive private health insurance offer is fully subsidised by Avant, meaning you can access benefits for services such as dental, optical, physio and more, without having to pay a premium. For more information and terms & conditions visit https://www.doctorshealthfund.com.au/liteextrascover.
I do not want to receive FREE Lite Extras Cover* from Doctors’ Health Fund.
If you are already a member of Doctors’ Health Fund, the fund will contact you to discuss an offer of equivalent value.
Application and declaration

Before submitting this Acceptance of Offer Form, please review the information you have provided and ensure that you have answered all sections. I declare that by submitting this form:

a. I have reviewed the information I have given in this Acceptance of Offer Form and that the information is true and correct, and I acknowledge that Avant Insurance will rely on this information in deciding whether I meet the criteria in making the offer above to me and that this form will be the basis of my policy.

b. I accept the offer of retroactive cover as set out in the policy and this Acceptance of Offer Form to the date that I started my internship or the date that I complete this Acceptance of Offer Form (whichever is earliest) and confirm that date will cover all my past uncovered incidents and I agree to accept all future offers of retroactive cover, unless I advise Avant Insurance otherwise in writing. If I decide not to accept any offer of retroactive cover or future offers of retroactive cover, I may be uninsured for incidents occurring prior to the commencement date of my policy.

c. I have read and understood the Product Disclosure Statement, Intern/RMO1 Indemnity Insurance Policy and Category of Practice Guide and I understand that the contract of insurance will be subject to the terms, conditions and exclusions of the policy or as otherwise specifically varied by Avant and agreed by me.

d. I accept this offer of membership of Avant and an Intern/RMO1 Indemnity Insurance Policy with Avant Insurance and agree to be bound by the Constitution of Avant and the terms of any insurance policy issued to me.

e. I accept that this Acceptance of Offer is subject to the terms above and receipt of the completed Acceptance of Offer Form by Avant and Avant Insurance.

f. I consent to Avant collecting, using, holding and disclosing my personal information (including sensitive information) in accordance with Avant’s Privacy Policy available at avant.org.au/privacy-policy.

g. I authorise Avant Insurance to obtain information or documents in relation to insurance matters or claims history from another insurance company, MDO or insurance reference bureau or similar organisation.

h. I understand that I may be required to participate in an audit. This may include the provision of a Statutory Declaration by me with regard to my category of practice and/or gross private practice billings (if any). I must cooperate and facilitate such an audit.

i. I accept that my policy will start from the date that I provide this completed Acceptance of Offer Form to Avant and Avant Insurance.

I confirm that I have read the Product Disclosure Statement (PDS) and Policy including the terms and conditions and exclusions applicable to cover: *
By submitting this Acceptance of Offer form I confirm the above and make these declarations: *



Avant Insurance Limited ABN 82 003 707 471 AFSL 238765 is a subsidiary of Avant Mutual Group Limited ABN 58 123 154 898

IMPORTANT: Professional indemnity insurance products available from Avant Mutual Group Limited ABN 58 123 154 898 are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. *Lite Extras is a private health insurance product issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Doctors’ Health Fund will collect and use the personal information provided on your Avant membership to issue and administer your Lite Extras policy. For more information and terms & conditions visit https://www.doctorshealthfund.com.au/liteextrascover or to view our privacy policy https://www.doctorshealthfund.com.au/privacy-policy. 3899/7015

Membership with Avant Mutual Group Limited ABN 58 123 154 898. Student Indemnity Insurance and Intern/RMO1 Indemnity Insurance with Avant Insurance Limited ABN 82 003 707 471 AFSL 238765. Version: August 2020

This is an Acceptance of Offer Form for Membership and a Student Indemnity Insurance Policy and an Intern/RMO1 Indemnity Insurance Policy and retroactive cover as a student and as an Intern/RMO1. This is a legal document, which will form (a) the basis of the contract of insurance between the insured (you) and Avant Insurance Limited (Avant Insurance); and (b) the basis of your contract of Membership with Avant Mutual Group Limited (Avant). When reading this document a reference to 'we', 'our' and 'us' will mean Avant Insurance. 'You' and 'your' will mean the insured.

By submitting this form or otherwise providing your personal information to Avant you consent to your personal information being collected, held, used and disclosed by Avant in accordance with the Avant Privacy Policy found here
http://www.avant.org.au/Privacy-Policy/.

The offer details on this form only apply if you meet the following selection criteria:

1. You must be a Medical Student who will, within six months of completing this Acceptance of Offer Form, become an Intern who is eligible or has professional registration from the Medical Board of Australia who will be engaged or is engaged in medical training in an Australian hospital.

2. You must only be performing work that is consistent with your category of practice as per the Category of Practice Guide.

3. You must have answered 'no' to all of the questions asked in the claims and history section of this form.

If you fall outside the selection criteria above this Acceptance of Offer Form does not apply to you – you will need to complete a full application form and return it to us so we can consider whether we will make an offer of insurance.
If you are unsure about any information to be supplied please contact Member Services on 1800 128 268.

* indicates compulsory fields

Contact Information

 



You will receive the product disclosure statement, renewal documentation, Financial Report and Annual Report electronically. If you wish to receive these by post, please email us at memberservices@avant.org.au
I consent to Avant contacting me in accordance with Avant’s Privacy Policy (including via email and SMS if you have provided your email address and mobile number). I understand that I may alter this consent at any time by contacting Avant.

You will receive the notice of Annual General Meeting and other member communications from Avant electronically to the email address you have nominated. If you wish to receive these by post, please contact us at memberservices@avant.org.au.

Please ensure that you maintain a current email address with us at all times so that we can ensure the successful delivery of communications to you. If you change address, change practice details or move overseas please let us know.
Professional Details

Note: If you are not a member of Avant your retroactive date for the purpose of the offer of retroactive cover as set out in the Student Indemnity Insurance Policy and for the period that the Student Indemnity Insurance Policy applies will be the date you complete this Acceptance of Offer Form. Avant Insurance offers retroactive cover from this date. If you are already a Student member your retroactive date for the purposes of your Student Indemnity Insurance Policy will remain unchanged and will remain for the period that the Student Indemnity Insurance Policy applies.

The retroactive date for the purpose of the offer of retroactive cover as set out in the Intern/RMO1 Indemnity Insurance Policy and for the period that the Intern/RMO1 Indemnity Insurance Policy applies is automatic to the date you first commenced work as an intern in Australia or the date that you complete this Acceptance of Offer Form (whichever is earliest). Avant Insurance offers retroactive cover from this date.

Claims, complaints, incidents or proceedings
If you answer YES to any of the following questions, this offer does not apply – please call 1800 128 268 and ask for an application form:
1. Have you ever had any claims or complaints or has there been an incident which may lead to a claim or complaint in connection with your training or from healthcare provided by you? *
2. Have you ever been counselled or disciplined in relation to alcohol or drugs? *
3. Have you ever been charged with, convicted or found guilty of a criminal offence? *
4. Have you ever made a self notification or been the subject of a voluntary notification to AHPRA? *
Membership and insurance offer
Period Policy Details $Amount
Student
If I am not an Avant member, from the date I provide this completed Acceptance of Offer Form to Avant Insurance to the date I begin my internship or 31 December 2020 (whichever is earliest) 		Avant Membership (inclusive of GST)

Avant Student Indemnity Insurance Policy

Retroactive cover from: the date I originally joined Avant as a Student member or the date that I completed this Acceptance of Offer Form (whichever is earliest) 		$0


$0
Intern
From the date I provide this completed Acceptance of Offer Form to Avant Insurance to 31 December 2021 		Avant Membership (inclusive of GST)

Avant Insurance Intern/RMO1 Indemnity Insurance Policy
Category of practice: Intern or RMO1. Retroactive cover from: the date first commenced work as intern in Australia or the date that I complete this Acceptance of Offer Form (whichever is earliest). 		$27.50


$0
As part of this Avant policy you are eligible for FREE Lite Extras Cover^ from Doctors’ Health Fund. This exclusive private health insurance product is fully subsidised by Avant, meaning you can access benefits for services such as dental, optical, physio and more, without having to pay a premium.
Yes, I want FREE Lite Extras Cover^ from Doctors’ Health Fund
By ticking this box you consent to have your personal information shared with Doctors’ Health Fund to issue and administer your Lite Extras Cover and that you have read, understood and agree to the terms and conditions of Lite Extras Cover available at www.doctorshealthfund.com.au/newinterns
You can view Doctors’ Health Fund privacy policy at www.doctorshealthfund.com.au/privacy-policy.
If you are already a member of Doctors’ Health Fund, the fund will contact you to discuss an offer of equivalent value.
Payment details *
Total amount: $27.50 (inc. GST)
I/We authorise Avant Insurance Limited (under User ID 010731) to arrange for payments, including payments for automatic renewal of my membership, to be debited from my/our nominated account through the Bulk Electronic Clearing System (BECS) in accordance with terms described in the Avant Insurance Direct Debit Request Service Agreement.
OR

I authorise Avant to charge my credit card for membership fees, including payments for the automatic renewal of my membership.

Application and declaration

Before submitting this Acceptance of offer Form, please review the information you have provided and ensure that you have answered all sections. I declare that by submitting this form:

a. I have reviewed the information I have given in this Acceptance of offer Form and that the information is true and correct, and I acknowledge that Avant Insurance will rely on this information in deciding whether I meet the criteria in making the offer above to me and that this form will be the basis of my policy.

b. With regard to the Student Indemnity Insurance Policy, I accept the offer of retroactive cover as set out in the policy and this Acceptance of offer Form from the date that I complete this Acceptance of offer Form or the date I originally joined Avant (whichever is earliest), and I agree to accept all future offers of retroactive cover, unless I advise Avant Insurance otherwise in writing. If I decide not to accept any offer of retroactive cover or future offers of retroactive cover, I may be uninsured for incidents occurring prior to the commencement date of my policy

c. With regard to the Intern/RMO1 Indemnity Insurance Policy, I accept the offer of retroactive cover as set out in the policy and this Acceptance of offer Form from the date that I started my internship or the date that I complete this Acceptance of offer Form (whichever is earliest) and confi rm that the date will cover all my past uncovered incidents and I agree to accept all future offers of retroactive cover, unless I advise Avant Insurance otherwise in writing. If I decide not to accept any offer of retroactive cover or future offers of retroactive cover, I may be uninsured for incidents occurring prior to the commencement date of my policy.

d. I have read and understood the Financial Services Guides, Product Disclosure Statements, Student Indemnity Insurance Policy, Intern/RMO1 Indemnity Insurance Policy, and Category of Practice Guide and I understand that the contract of insurance will be subject to the terms, conditions and exclusions of the policy or as otherwise specifically varied by Avant and agreed by me.

e. I accept this offer of membership of Avant and a Student Indemnity Insurance Policy and an Intern/RMO1 Indemnity Insurance Policy with Avant Insurance and agree to be bound by the Constitution of Avant and the terms of any insurance policy issued to me.

f. I consent to Avant contacting me in accordance with Avant’s Privacy Policy (including via email, if I have provided my email address). I understand that I may alter this consent at any time by contacting Avant.

g. I authorise Avant Insurance to obtain information or documents in relation to insurance matters or claims history from another insurance company, MDO or insurance reference bureau or similar organisation.

h. I understand that I may be required to participate in an audit. This may include the provision of a Statutory Declaration by me with regard to my category of practice and/or gross private practice billings (if any). I must cooperate and facilitate such an audit.

i. I accept that my policies will start from the date that I provide this completed Acceptance of offer Form to Avant and Avant Insurance or, as described above, the date I started my internship.

I confirm that I have read the Financial Services Guide (FSG)/Product Disclosure Statement (PDS) and Policy including the terms and conditions and exclusions applicable to cover: *
By submitting this Acceptance of Offer form I confirm the above and make these declarations: *



Avant Insurance Limited ABN 82 003 707 471 AFSL 238765 is a subsidiary of Avant Mutual Group Limited ABN 58 123 154 898

IMPORTANT: Professional indemnity insurance products available from Avant Mutual Group Limited ABN 58 123 154 898 are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. ^An exclusive, extras only, private health insurance product issued by The Doctors' Health Fund Pty Ltd ABN 68 001 417 527, fully subsidised by Avant as part of your policy. For more information, including benefit limits and terms and conditions visit www.doctorshealthfund.com.au/newinterns 3899/7015

Thank you for joining Avant.


Your Acceptance of Offer form will be processed within the next 7 days.


A Welcome letter and Policy Schedule will be sent to your nominated email address upon receipt of payment.


If you have any questions please contact Avant Member Services on 1800 128 268 or email applications@avant.org.au


IMPORTANT: Professional indemnity insurance products available from Avant Mutual Group Limited ABN 58 123 154 898 are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268.