New Member Application

Member Applicant Health Declaration

I declare I am in good health and I am not aware of any health condition I have which may prevent me from becoming a member of the Ambulance Provident Fund Limited (APF / the Fund). I also declare I have not had any medical, hospitalisation, accident or life insurance application rejected or cancelled, or restricted, or subject to special terms, or renewal declined due to any medical condition.

I understand I am eligible to be a Member as I am currently employed by the NSW Ambulance Service, or I am eligible to be an Associate Member due to meeting the requirements of an Associate membership in the Fund's Rules.

I understand and agree my application will be effective only if it is accepted by the Board of the APF and the applicable joining fee has been paid. I also understand I must keep my applicable membership fees financial by Board approved options to maintain current membership.

I agree this Member Health Declaration signed by me shall be the basis of the contract between the proposed member as named above and the APF and I agree to accept the terms and conditions as set by the Board and its members from time to time.

I understand the personal information provided within this form is protected by the Privacy and Personal Information Protection Act 1998 (NSW) and access to the information provided in this form is only available to myself and those persons authorised to access this information in the course of their duties with the Fund.

I hereby declare that the foregoing statements and particulars are true and complete and I have not withheld any information that may influence the acceptance of my application.

I declare the above to be true 

Privacy Collection Notice – APF Membership

The Ambulance Provident Fund Limited (APF) is regulated by the Privacy Act 1988 (Cth), which protects the privacy of your personal information. The purpose of this Privacy Collection Notice is to let you know what information is collected about you and how the information is used by APF. APF takes all reasonable steps to protect personal information held in its possession against loss, unauthorised access, use, modification, disclosure or misuse.

Purpose of Collection

The information collected on this form, by the Ambulance Provident Fund (APF), is collected for the purpose of:

• communicating with you regarding your application for APF membership;
• verifying your identity and employment and eligibility for APF membership;
• corresponding with you once you join as an APF member, for example to inform you about membership options and membership renewal and sending you payment reminders;
• managing your APF membership status, contact details and the maintenance of your nominated beneficiary contact details;
• managing membership reporting and business analytics to improve membership programs, opportunities, services and ways in which we engage with you as an APF member;
• verifying your details with our partners, such as employers, like member organisations and financial service providers, to confirm membership referrals, account for funds, reconnect with lost members, and/or to enable us to continue to provide our services to you; and
• providing you with direct marketing, including emails and SMS communications. You can opt out of our direct marketing at any time.

Consequences of refusing

You are not required by law to provide us with your personal information for the above purposes, however, if you choose not to give APF certain information then APF may be unable to process your request for membership or communicate or engage with you as an APF member or send you direct marketing and notices.

Disclosure of information to third parties

• external service providers used to send you notifications about membership benefits, including discounts and offers;
• external service providers who provide services to us, such as printing companies who print and send out APF marketing and information materials; and
• our partners, such as employers, like member organisations and financial service providers, to confirm membership referrals, account for funds, reconnect with lost members, and/or to enable us to continue to provide our services to you.

APF will not otherwise disclose your information without your consent unless required or authorised to do so by law.

You have a right to access and amend personal information that APF holds about you. If you wish to seek access to your personal information or inquire about the handling of your personal information please contact our Secretary, visit our Privacy Policy or review your online profile where most of your information is held.