Authorised caller

Note: If the person being added as an authorised caller has enduring power of attorney, please use our enduring power of attorney enquiry form.

By continuing this form, I understand that:

• the Nominated Person will not be able to access MySouthernCross on my behalf;
• the Nominated Person will only have access to information relating to me and my insurance cover under the policy I am covered under;
• Southern Cross will not be responsible for any actions taken by the Nominated Person;
• this authority will be effective from the date on which Southern Cross receives this form;
• I can cancel this authority at any time by contacting Southern Cross.

By continuing this form, I understand that:

• the Nominated Person will not be able to access MySouthernCross on my behalf;
• the Nominated Person will only have access to information relating to me and my insurance cover under the policy I am covered under;
• Southern Cross will not be responsible for any actions taken by the Nominated Person;
• this authority will be effective from the date on which Southern Cross receives this form;
• I can cancel this authority at any time by contacting Southern Cross.

By continuing this form, I understand that:

• Southern Cross will not be responsible for any actions taken as a result of instructions received by the Nominated Person;
• this authority to act will be effective from the date on which Southern Cross receives this form;
• I can cancel this authority at any time by contacting Southern Cross.

By submitting this form, you acknowledge and agree that personal and health information provided to us (including any supporting documents) will be collected, stored, used and disclosed in accordance with the terms of our Member Privacy Statement.