Claim Form - This is a claim form that must be printed and signed before being returned to the Trust with supporting documentation. Click to download here.



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NZR Staff Welfare Trust – Extended Health Plan and Group Life Plan
Application for Information


I am interested in receiving further information about joining the Extended Health Plan or the Group Life Plan including details of premium rates:
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Name (in full):*
Email:*
Postal Address:*
Telephone Number (work):*
Telephone Number (home):*
   
Member identification number:*
   
I am interested in information etc regarding (check as appropriate):
Extended Health Plan (Southern Cross) Extended Health Plan (Consignia) Group Life Plan
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