Your details
Cover options
Are you interested in these cover options?
Gender
Are you a smoker?
Optional questions

The following questions are optional but can help us ensure the right person contacts you back.

Things you should know.

The information we collect on this form will be used by us to respond to the query you have provided. It may be disclosed to service providers who do things on our behalf (e.g. a mailing house) or to other third parties where it is required or allowed by law or where you have otherwise consented.

You can access and seek correction of the information we have collected, if we have retained it, by telephoning 0800 400 600.

Term Cover is arranged by Westpac New Zealand Limited ("Westpac") and underwritten by Westpac Life-NZ-Limited (“Westpac Life”), which is a wholly owned subsidiary of Westpac Financial Services Group-NZ-Limited, which is a wholly owned subsidiary of Westpac Banking Corporation ABN 33 007 457 141, incorporated in Australia. None of Westpac Banking Corporation, Westpac, or any member of the Westpac group of companies guarantee the obligations of, or any products issued by, Westpac Life. More detail can be found on the webpage relating to the particular product. Westpac will receive commission payments as a result of the arrangement of Westpac Life insurance policies. See Westpac Life’s Solvency. See Westpac Life's Financial Strength Rating.