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CWU SIC Application | Halligan Insurances
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01 879 7100  
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Halligan Insurances
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    • Apply online for CWU Specified Illness Cover for yourself & your partner

    • Prior to completing this form please ensure that you fully understand all the questions and notes.
    • Before you give us your personal information it is important that you know what your data protection rights are and how and why we use your personal information. This is set out in the Irish Life Data Privacy Notice which is always available on the website at irishlifecorporatebusiness.ie or you can ask for a copy.
    • Spouse SIC Only Joining Section

    • ** NB In order for the Spouse/Civil Partner to be eligible, the Member needs to be in the SIC Scheme or be applying to enroll.
    • *
    • Table Break

    • Section 1: Member Details

    • Please use both the first name and surname in your employee records
    • Hide Age Validation on Spouse Only Cover

    • All Applicants must be over 18 and under 60 years old
    • Table Break

    • Section 2: Partner Details

    • Please use both the first name and surname in your employee records
    • All Applicants must be over 18 and under 60 years old
    • Section 3: Cover Options

    • Table Break

    • CWU SPECIFIED ILLNESS COVER BENEFITS
      CWU SIC Cover Plan – Table Cover
      AGE OF MEMBER & SPOUSE FULL BENEFIT COST FOR MEMBER & SPOUSE 
      Age 18-34 €50,000 SIC €2.00 per week
      Age 35-44 €45,000 SIC €3.94 per week
      Age 45-54 €20,000 SIC €3.94 per week
      Age 55-64 €15,000 SIC €3.94 per week
      Children's Benefit Age 0 to 24

      €20,000 SIC

      €10,000 Life Cover*

      Included
    • *Claim Benefit paid based on your age at the time of the claim.
    • Member Specified Illness Cover Selected

    • Price: € 0.00
    • Price: € 0.00
    • Partner Specified Illness Cover Selected

    • Price: € 0.00
    • Price: € 0.00
    • (Your premium increases to the normal rate at age 35)
    • Please refer to the explanatory booklet. Your cover is related to your age at date of claim.
    • Warning: The current premium may increase after the next review of the scheme.
    • Section 4: Declaration

    • Warning: The current premium may increase after the next review of the Specified Illness Cover scheme at 01/06/2021.
    • Please read the declaration below carefully and ensure that you fully understand it before signing it. If you cannot complete this declaration, please contact your financial advisor for further information.
    • Any words in the singular also mean the plural as applicable (e.g. ‘I’ means ‘we’ and ‘my’ means ‘our’ etc.)
    • Specified Illness Declaration (SIC)
    • I understand and agree that my contract with Irish Life Assurance plc (Irish Life) will be based on the declarations in this form, my completed application form (online or otherwise), any supplementary questions answered, any statements made to Irish Life in writing or by telephone, and all terms and conditions given to me by Irish Life.
      I, a member of CWU, (or a spouse/civil partner/partner of a member of CWU) confirm that I have read and fully understand the corresponding booklet in relation to CWU Group Specified Illness Cover plan including the sections on pre-existing conditions and the six-month cancer moratorium and accordingly I now apply to join this plan.
      I understand that where I have a medical history, previous medical conditions or symptoms described in the pre-existing conditions clause, Irish Life will not pay a claim and I may encounter difficulty in obtaining cover elsewhere.
      I also understand that this is a reviewable scheme and the benefits and/or costs can change at the next review date.
      I declare that all information, statements and answers I have provided, are true and complete.
      I understand that Irish Life can use my personal information for any subsequent applications to Irish Life.
      I can confirm that I have received, read and understand the key features of the scheme booklet.
      I confirm I have been informed about the Irish Life Data Privacy Notice and where to find it.
    • Member's SIC Signature View

    • *
    • *
    • Partner's SIC Signature View

    • *
    • *
    • Table Break

    • Section 5: Optional Consent

    • I agree to Irish Life Assurance plc sharing my personal information (excluding my personal health information) with other companies within the Irish Life Group, such as Irish Life Health. I understand this is to assist in developing combined customer services (for example, access to services from different Group companies on one online platform). This is an area that will continue to improve with a view to adding new customer engagement offerings. You can change your mind at any time and opt-out of any further sharing by emailing cbconsentoptout@irishlife.ie or writing to Irish Life Data Protection Team. If you opt-out we will keep a record of your instruction to opt-out.
    • Section 6: Salary Deduction Mandate

    • The Trustees of the CWU AVC Life Assurance Plan have appointed Halligan Insurances to collect the appropriate premiums from plan members on the Trustees behalf and to submit these to the underwriter of the Plan. The underwriter of the plan, as of 1 September 2019 is Irish Life Assurance plc. The Trustees will notify members of any change of underwriter that may occur in the future. It is each employer's responsibility to apply tax relief at source where applicable. Please read the Halligan Insurances Privacy notice here https://halligan.ie/privacy-statement/
    • Please deduct from my salary the appropriate contribution under the selected plan(s).
      I recognise that these deductions, being made solely as a measure of convenience to me, may be terminated at any time.
      I also recognise that the ultimate responsibility for ensuring that the deductions have, in fact, been made from my salary rests with myself, and that, beyond making remittances in accordance with the arrangements approved, the employer accepts no responsibility of any kind in that matter.
    • *
    • Submit Section

    • Click Submit to send Application forms to Halligan Insurances.
      Please don't close or click back on your browser after clicking Submit.
      A confirmation page will be displayed when completed.
    • Halligan Life & Pensions Ltd t/a Halligan Insurances, Good Insurance is regulated by the Central Bank of Ireland.
  • REQUEST A CALL BACK

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Halligan Insurances, William Norton House, 575 North Circular Road, Dublin 1
 info@halligan.ie 
 01 879 7100
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Halligan Life & Pensions Ltd t/a Halligan Insurances, Good Insurance is regulated by the Central Bank of Ireland. Registered Number: 120399. Company Directors: M. A. Halligan, B. A. Halligan, B. T. Halligan, G. M. Halligan.
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