Online Student

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

Privacy Notice: Avant Mutual Group Limited and its related entities (Avant) collects, uses and discloses your personal information to communicate with you, conduct our business (including marketing, research and providing Avant products and services) and comply with the law. This may include disclosing information to overseas entities which are not accountable under Australian privacy laws and you may not be able to seek redress for a breach of your privacy which occurs outside of Australia. If you don’t provide your information we may not be able to assist you or provide our products or services. For more information please read our Privacy Policy at avant.org.au/privacy-policy or contact our Privacy Officer at privacy@avant.org.au. By submitting this form or otherwise providing your information you confirm that you understand, acknowledge and agree to your information being collected, used and disclosed as outlined above and in accordance with the Privacy Policy. You can contact us at any time if you have any questions or wish to change your consent.

1. Contact Information

IMPORTANT: Student indemnity insurance is issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. Please read the relevant Product Disclosure Statement and policy wording (available at avant.org.au ) for full details of the terms, conditions and exclusions that apply.

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Date of birth: *	(dd/mm/yyyy)
Country of birth: *
Do you require a student Visa to study in Australia: *	Yes No
Residential address line 1: *
Residential address line 2:
Residential address line 3:
City: *
State: *
Postcode *
Alternative address line 1:
Alternative address line 2:
Alternative address line 3:
City:
State:
Postcode:
Mobile: *	e.g. 0400111222
and/or alternative phone: *	e.g. 0386735015
Email: *
Validate email: *
Alternative email:
You will receive the Policy Wording, renewal documentation, Financial Report and Annual Report electronically. If you wish to receive these by post, please email us at memberservices@avant.org.au.
avant.org.au via email by post
I consent to Avant contacting me in electronically (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.
	Yes No
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.
	Email Post