NurseWiseApplicationExp2026

Before you begin

Please ensure you are aware of the following before you apply:

The relevant policy and disclosure documents including the FSG, Policy Schedule and Policy Wording are available for review prior to arranging cover at www.nursewise.com.au/downloads
All prices quoted are in Australian dollars (AUD)
NurseWise cover renews on the 15th of November each year for all members. The rates quoted in our form below are for cover from your inclusion date, up till the 15th of November 2026. Your inclusion date is the date you apply for cover, or the start of the new policy period when you are applying to renew your cover.

Important Notice: By proceeding, you confirm that you have read your Duty of Disclosure.

Are you a current NurseWise member? *

YesNo

If your previous cover has been expired for more than 3 months please select no.

NurseWise Member Number *

As mentioned above, NurseWise cover renews on the 15th of November each year for all members.

The rates quoted in our form below are for cover from your inclusion date, up till the 15th of November 2026. You can elect to be included now or from the new policy start date (15th of November 2025), please select an option below to proceed:

Preferred Inclusion Date *

Start my cover nowStart my cover from the 15th of November

Contact Information

Prefix

First Name *

Last Name *

Mobile Phone *

Home Phone

Business Phone

Email Address *

Your Address

Street Address *

Street Address Line 2

City *

State *

Non AU State *

Postcode *

Country *

Your Details

Date of Birth *

AHPRA Registration Number *

Qualifications *

Employer *

Coverage Option

Occupation Selected *

Would you like to add cover for a second occupation? (additional fees may apply)

Second Occupation *

reference

Months Charged *

PI Base Occ 1 *

PI Base Occ 2 *

PL Base Occ 1 *

PL Base Occ 2 *

Higher PI Base *

Higher PL Base *

Base Subtotal *

Base Total *

Base GST *

PI Stamp Duty Rate *

PL Stamp Duty Rate *

PI Stamp Duty Charge *

PL Stamp Duty Charge *

Stamp Duty *

Broking Fee *

Broking Fee GST *

Coverage Cost - Includes GST

GST Included

History

Are there any claims alleging a negligent act, error or mission or malpractice currently lodged against you? *

YesNo

Are you aware of any circumstance which has already occurred which may give rise to a negligent act, error or omission or a malpractice claim being lodged against you? *

YesNo

Have you been involved in any action which could have or did give rise to a legal dispute arising out of your employment? *

YesNo

Have you ever been involved in professional discipline procedures? *

YesNo

Have you ever been refused any insurance, or had a requirement for harsher terms and conditions imposed upon your application for insurance? *

YesNo

History Details

Please tell us why you said YES to any of the history questions.

We will contact you for more information if required.

Please provide details *

If you have previously provided us with full details of the matter disclosed above during a previous renewal and you have no new information/matters to disclose, please select yes to the below. This will enable us to verify our records and process your renewal promptly.

Have you previously provided us with full details of this matter? *

YesNoUnsure

Payment Information

Payment Method *

Bank TransferPay Online Now

Please note: A1.4% + $0.30 online card payment charge applies

Bank Transfer Payment Details

Please note - your cover is not in place until payment has been received and policy documents have been issued. Your policy documents will be sent to your email address provided above.

Please note: Our bank account details have recently changed.

Account Name Coverforce Partners Pty Ltd - Gamman Sweep Bank Account

BSB 182222

Account no. 306979261

Reference: Please use your NurseWise member number.

If you are not a current member please use your surname and year of birth. For example: "Smith1972"

Amount to Pay (Includes GST)

Payment Amount (Includes GST and Card Payment Fee)

Card Payment Fee Included

Pay Now *

Pay

Data Protection and Privacy Policy

Coverforce is committed to protecting your privacy. As part of this application, we collect and manage your personal information for the purposes of arranging cover as a NurseWise member. Any personal information provided will be handled in accordance with our Data Protection and Privacy Policy, which outlines how we manage, store, and protect this data.

Click here to read our Data Protection and Privacy Policy.

Click below to submit your application

Please be aware your cover is not in place until you receive your Certificate of Insurance. After receiving your application our team will confirm your eligibility and ensure payment has been received, prior to sending your Certificate of Insurance through to the email you have provided above.

If you urgently require cover, or if you have any other queries please contact us during business hours for assistance.

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Application Date

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