New Member Application

I hereby wish to apply for membership to Hunter Health Insurance (CDH) and agree to abide by the rules and regulations as laid down by this organisation. I would further certify that neither myself nor any dependant covered under this membership, has to the best of my knowledge any pre-existing or chronic illness other than those listed at the date of this application.

I hereby authorise Hunter Health Insurance (CDH) on my behalf to obtain the Clearance Certificate and cancel my membership including any payment arrangements with from the start date of my policy with Cessnock District Health Benefits Fund.

I / we request Cessnock District Health Benefits Fund Dr - 088892 to arrange for funds to be debited from my nominated financial institution as provided above.

Please note: Joint Accounts require both signatures.