07 March 2015

Our Ref No. 00260544-153C

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Mr Jamie Hurst
8 Cranstons Rd
MIDDLE DURAL NSW 2158

Dear Mr Hurst,

Slinky's new Woolworths Pet Insurance Policy (WW02930670) starts at 23h59 on 07

March 2015
We'd like to welcome you and Slinky to Woolworths Pet Insurance^.
With your Woolworths Pet Insurance policy you can rest assured that Slinky can get the best of care without you worrying
about the bill. #
Included in your welcome pack you'll find:

Certificate of Insurance -This details premiums and benefits of your cover.

Claim and Cruciate Ligament Examination Forms - For every visit to the vet, both you and your vet will be
required to fill in a Claim Form if you wish to make a claim. Please ensure that you obtain a full vet history from
your vet (and any previous vet/s who have treated your pet) to include with your first claim so that your claim can
be processed promptly.
Product Disclosure Statement, Policy Terms and Conditions, Financial Services Guide - Please ensure that
you have read through these carefully.

Please keep these items in a safe place as you may need to refer to them in the future.
Important information:
Your first Fortnightly premium for Slinky's new policy is due on 07 March 2015. This will be collected by us directly from
your nominated credit card account.
If you would like more information about your Woolworths Pet Insurance policy, please visit
woolworths.com.au/insurance or please call our friendly Customer Service Team on 1300 10 1234 between 8am and 8pm
(AEST) Monday to Friday (except public holidays).
Yours sincerely

Chris Cramond
Head of Woolworths Insurance

# Subject to the Terms and Conditions of the Woolworths Pet Insurance policy.
^ Woolworths Pet Insurance is issued by the insurer The Hollard Insurance Company Pty Ltd ABN 78 090 584 473 AFSL 241436
("Hollard"). Woolworths Ltd ABN 88 000 014 675 acts as an authorised representative for Hollard (AR No. 245476).
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Policy No: WW02930670

Certificate of Insurance
& Tax Invoice

Issued on 07 March 2015 by

The Hollard Insurance Company Pty Ltd
ABN 78 090 584 473 AFSL 241 436

Mr Jamie Hurst
8 Cranstons Rd
MIDDLE DURAL NSW 2158
Insured Pet Details

Annual Benefit Limits & Sub-Limits (incl. GST)

Name

Slinky

Species

Canine

Overall policy annual Benefit Limit subject to the following sub-limits:

Gender

Female

Date of Birth

10 January 2015

Breed

Miniature Dachshund - Smooth Haired

$10000.00

Paralysis Tick Illness Treatment - annual

sub-limit

$1000.00

Emergency Boarding Fees - annual

sub-limit

$1000.00

Policy Details
Special Policy Conditions
Plan (Selected cover option)

Standard Cover

Commencement Date

07 March 2015 (23h59)

End Date

07 March 2016 (23h59)

Additional policy exlusions :

Level of Cover
Benefit Percentage
Condition Excess

80%
$100.00

Premium Details
Payment Frequency

Fortnightly

Nominated Debit Day

Method of Payment
Insurer's Premium

7th
Credit Card
$14.56

GST

$1.46

Stamp Duty

$1.44

Fortnightly Instalment

$17.46

This document becomes a Tax Invoice on the payment of

each instalment.

Telephone: 1300 10 1234 Fax: 1300 367 229

Postal Address: Locked Bag 9021, Castle Hill, NSW 1765
Website: www.woolworths.com.au/insurance Email address: petinsurance@woolworths.com.au
Promoted by: Woolworths Ltd ABN 88 000 014 675 (A.R. No. 245476)
Administered by: PetSure (Australia) Pty Ltd ABN 95 075 949 923 (AFSL No. 420 183)
Underwritten by: The Hollard Insurance Company Pty Ltd ABN 78 090 584 473 (AFSL No. 241436)

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The policy and the cover provided by it is issued exclusively to the policyholder and insured
pet printed on this Certificate of Insurance and is not transferrable.

Woolworths
Pet Insurance

Cruciate Ligament Examination Form

Your Woolworths Pet Insurance policy has a waiting period of 6 months starting from the initial commencement date of the policy
for cruciate ligament (and related) conditions. This waiting period may be reduced to the policy commencement date depending
on the results of a veterinary examination of your pet.
To apply for this waiting period to be waived:
Your vet must examine your pet and complete and sign this form (at your expense) on or after the policy commencement date.
The completed and signed form must be received within 14 days of the examination date.

Your (Policyholder) Details:

Woolworths Pet Insurance
Policy Number:
Title:

Surname:

First Name:

Suburb:

State:

Postcode:

Pet's Details: (Please complete one form for each insured pet)
Name:

Dog:

Breed:

D.O.B:

Cat:

Important
You will receive written confirmation from us in the event that the waiting period for cruciate ligament conditions in respect of your
pet is reduced. Unless you receive such written notification, the waiting period in respect of the pet identified on this form remains
at 6 months starting from the policy commencement date.

Vet to complete sections overleaf

Please mail completed form to Woolworths Pet Insurance, Locked Bag 9021, Castle Hill, NSW 1765
or Fax BOTH SIDES OF THIS FORM to 1300 367 229
Woolworths Pet Insurance is issued by The Hollard Insurance Company Pty Ltd ABN 78 090 584 473, AFSL 241436 (Hollard); administered by PetSure (Australia) Pty
Ltd ABN 95 075 949 923 AR No. 268991 as an authorised representative of Hollard; and promoted by Woolworths Limited ABN 88 000 014 675 AR No. 245476 as an
authorised representative of Hollard. Neither Woolworths Limited nor any of its related entities, directors or employees guarantees the assessment or payment of claims
under any policy issued and underwritten by Hollard.
Please note that issuance or completion of this form does not constitute an automatic waiver of the cruciate ligament waiting period.

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Address:

To Be Completed by Veterinarian
Veterinarian's Guidelines: Please physically examine the pet as indicated (no other diagnostic tests are required).
Please tick YES or NO that best describes your findings, and add further details in the NOTES section at the end of this form.
Please keep detailed notes in this pet's clinical records.
Owner's
Surname:
Pet's name:

Examination
Date:

Owner History
Has the owner ever reported a history of the pet limping or difficulty arising?
(If yes please provide a copy of the clinical records)

Yes

No

Yes

No

Positive Cranial Drawer Test

Yes

No

Tibial Compression Test

Yes

No

Yes

No

Is there crepitus, or any other abnormality, in the joints?

Yes

No

Are the joints thickened, or are there indications of past injury or surgery?

Yes

No

Yes

No

Clinical Observation
Observe the pet walking, trotting and arising from a seated position
Were there any observable signs of clinical lameness?

Clinical Examination
The clinical examination is performed without sedation or anesthetic
Is there joint laxity in the knee joint? Detected by:

Pain or Discomfort on Palpation

Is there pain on palpation of the hind legs including hips and low spine?
(If yes indicate the areas where pain was elicited on palpation in notes)

Joint Abnormalities

Conclusion
Are there any findings or evidence of anterior cruciate disease?

Veterinarian's Notes (Please note location and nature of any positive findings)

Examining Veterinarian's Declaration

Signature of
veterinarian:

Date:

Signature of
pet owner:

Date:

Name of attending veterinarian

and practice: (Please print)
Please note that issuance or completion of this form does not constitute an automatic waiver of the cruciate ligament waiting period.

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I certify that the animal described on this certificate, and named above, has the clinical history and clinical signs as detailed above,
and that the information provided by me on this form is truthful, accurate and complete.

Woolworths
Pet Insurance
Veterinary Fee Claim Form
Claims should be submitted in writing and received with the original itemised invoice(s) within 90 days of the vet
treatment being provided. Faxed claims will not be accepted. Note: If this is your first claim please attach
a complete veterinary history (medical records) from all current and previous veterinary clinics. If you have
previously provided this information to us, or if it is a routine care claim, you do not need to provide it.

Part 1: To be completed by you, the policyowner

Policy number:

Your pets details

Your pets name:
Gender:

Male

Female

Pets age/D.O.B.

Species:

Dog

Cat

Desexed:

Yes

No

Colour:

Breed:

Your details
Title:

First name:

Surname:

Address:
Suburb:
Phone:

State:
(home)

(work)

Postcode:

(mobile)

Email:
Please tick if there has been a change of address or contact details:

If you are registered for GST and are entitled to a GST Input Tax Credit (ITC) on your premium, what is the ITC percentage?
By leaving these details blank, the insured confirms that no entitlement to GST ITC exists.

Part 2: To be completed by the vet to ensure efficient processing of your claim

Is this claim for Routine Care? If yes, simply attach the invoice and complete the declaration below.
Type and cause of injury or condition/diagnosis

Date of treatment

Dates of first clinical signs

(include dates of previous related or similar conditions)

Total charge

Summary: Please attach radiology, pathology reports and consultation notes where applicable
How long has this pet been
Less than 6 months
More than 6 months
a client of your clinic?
Case notes:

Date of last vaccination/booster:

Type of vaccination:

Declaration
I/we certify that the information given in this form is truthful, accurate and complete. No information likely to affect this claim has been withheld. I/we understand that
deliberate misrepresentation of the animals condition or the omission of any material facts may result in the denial of the claim and/or cancellation of the policy. I/we
confirm that the veterinary services as detailed in the account(s) submitted with this claim have been provided and I/we understand that policy administrators will assess
the claim in accordance with the cover selected and benefits payable by the policy. I/we authorise any veterinary surgeon who has treated my/our pet to provide to the
insurer any details they may require. Please note that issuance or completion of this form does not acknowledge liability or guarantee payment of the claim.

Signature of
pet owner:

Date:

Signature of
veterinarian:

Date:

Veterinarian registration no:

Name of attending veterinarian and practice: (please print)

Registration state:

Please mail your completed claim form to: Woolworths Pet Insurance, Locked Bag 9021, Castle Hill, NSW 1765

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ABN:

Make a claim in three easy steps

Step One:

Fill in your and your pets personal information and sign the claim form.

Step Two:

Take the form to your vet, and ask your vet to complete in full Part 2 and sign the form.

Step Three:

Attach the original detailed itemised invoices and payment receipts to the completed claim form. Please do not staple
documents. Ensure your vet includes their practice details on the original invoice.
Then mail your completed claim form to: Woolworths Pet Insurance, Locked Bag 9021, Castle Hill, NSW 1765

How your claim is assessed

Once the necessary documentation is received, your claim will be processed without delay.
In some cases veterinary records may be requested to assist in understanding some aspect of your claim to ensure it is processed
correctly and fairly.

How your claim will be paid

If you have elected to pay your premiums by direct debit your benefits will be paid directly into your nominated bank account.
If you have elected to pay your premiums by credit card you will receive a cheque in payment of your benefits. Following the
payment of your claim you will also receive a statement confirming payment.

Claim checklist (Please do not staple documents)

Before sending in your claim, please ensure you have:
Completed the Claim Form
Attached the original itemised invoice
Signed Veterinarian Claim Form
Attached a full veterinary history (medical records from previous veterinary visits)
if this is your first Accident or Illness claim (no history is required for Routine Care claims)
Attached adoption certificate (if this is an adopted or rescued pet)
Please note: All claims should be submitted and received within 90 days of treatment

Need more claim forms?

You can access copies of this form online at woolworths.com.au/insurance or by calling 1300 10 1234 between 8:00am 5:00pm
(AEST), Monday to Friday (except public holidays).
Disclaimer: It is a criminal act to make a false or fraudulent claim under an insurance policy or to assist in the preparation or
presentation of a false or fraudulent claim under a policy. Violators of this provision may be subject to criminal prosecution.

For any claim enquiry, please call 1300 10 1234 between 8:00am 5:00pm Monday to Friday (AEST)
(except public holidays)
Woolworths Pet Insurance is issued by The Hollard Insurance Company Pty Ltd ABN 78 090 584 473, AFSL No. 420183 Hollard; administered by PetSure (Australia) Pty Ltd
ABN 95 075 949 923, AR No. 268991 as an authorised representative of Hollard; and promoted by Woolworths Limited ABN 88 000 014 675, AR No. 245476.
Neither Woolworths Limited nor any of its related entities, directors or employees guarantees the assessment or payment of claims under any policy issued and underwritten by Hollard.

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Please mail your completed claim form to: Woolworths Pet Insurance, Locked Bag 9021, Castle Hill, NSW 1765