Accelerated Protection Application - Ordering Information

1 Accelerated Protection Application | PAGE 1 OF 32 This form applies to insurance cover structured: youtside of superannuation, and ythrough superannuation (where the policy is owned by the trustee of the fund).If you are applying for insurance cover through superannuation, references to the Fund and the Trustee in this form are to: yTAL Super (the Fund) a plan within the Retail Division in the Mercer Super Trust ABN 19 905 422 981, and yMercer Superannuation (Australia) Limited ABN 79 004 717 533, AFSL 235906 (the Trustee).

2 Reference number (Please ensure the correct quote illustration is attached to this Application Form.)Life to be insured 1 name IMPORTANT INFORMATIONP roduct Disclosure Statement (PDS)Before you apply for new insurance cover or change your existing policy, you should read the PDS relevant to your policy. For new applications , TAL or a financial adviser must have provided you with an Accelerated Protection Combined Product Disclosure Statement and Policy Document (PDS) and, if your cover is to be structured through TAL Super, the Accelerated Protection through TAL Super Product Disclosure Statement (TAL Super PDS)

3 , dated 27 March 2020 prior to you submitting your you are requesting a change to an existing policy, you should refer to the PDS issued at the time you applied for your policy, and any updates to that this formPlease complete all relevant sections. If you do not provide the required Information , we may not be able to process your Application . You can submit this form by mail, email or fax (see last page for details). Alternatively, your financial adviser may submit an electronic Application to complete in black ink, using BLOCK letters.

4 Use X in ProtectionApplicationTALR0087/0320 TAL Life Limited ABN 70 050 109 450 | AFSL 237848 This form is dated 27 March 2020 TALR0087 0320 AP App Form 110/3/20 2:45 pmACCELERATED Protection Application | PAGE 2 OF 32 Application DETAILS1. How many lives insured apply to this Application ? 1 2 3 4 5 If there is more than one life to be insured, you will need to complete a Personal Statement form for each 2 name Life 3 name Life 4 name Life 5 name 2.

5 How many policies apply to this Application ? 1 2 3 4 DUTY OF DISCLOSUREB efore you enter into or become insured under an insurance contract with us, you and any life to be insured are required under the insurance Contracts Act 1984 to provide us with the Information we need to decide whether we ll accept your Application for insurance , what terms will apply and what your premium will be. For the purposes of this Duty of Disclosure section, You includes both the Policy Owner and the Life have this duty until we agree to insure you.

6 You have the same duty before you extend, vary or reinstate an insurance contract. You do not need to tell us anything that: yreduces the risk we insure you for yis common knowledge ywe know or should know as an insurer, or ywe waive your duty to tell us the insurance is for the life of another person and that person does not tell us everything they should have, this may be treated as a failure by you to tell us something that you must tell you do not tell us somethingIn exercising the following rights, we may consider whether different types of cover can constitute separate contracts of life insurance .

7 If they do, we may apply the following rights separately to each type of you do not tell us anything you are required to, and we would not have insured you if you had told us, we may avoid the contract within three years of entering into it. If we choose not to avoid the contract, we may, at any time, reduce the amount you have been insured for. This would be worked out using a formula that takes into account the premium that would have been payable if you had told us everything you should have.

8 However, if the contract has a surrender value, or provides cover on death, we may only exercise this right within three years of entering into the we choose not to avoid the contract or reduce the amount you have been insured for, we may, at any time vary the contract in a way that places us in the same position we would have been in if you had told us everything you should have. However, this right does not apply if the contract has a surrender value or provides cover on your failure to tell us is fraudulent.

9 We may refuse to pay a claim and treat the contract as if it never you have applied for your Accelerated Protection Policy via a financial adviser it is also your responsibility to ensure that the Information provided to your financial adviser is accurate and complete and that the correct Information is entered into the paper or electronic Application PERSONAL DETAILST itle Mr Mrs Miss Ms Other First name Middle name Last name Previous last name Date of birth DD / MM / YYYYG ender Male FemaleTALR0087 0320 AP App Form 210/3/20 2:45 pmACCELERATED Protection Application | PAGE 3 OF 321.

10 PERSONAL DETAILS (continued)Tax file number Only provide this if you are applying for cover through TAL Please refer to Section 35 for Information about providing your tax file number. If the life to be insured has been pre-assessed for this Application and a Pre-assessment Reference Number provided, please enter below. Do not include phone call Reference Number 1 Pre-assessment Reference Number 2 Residential addressDo not enter a PO Box in this field. If your mailing address is different to your residential address, please complete your residential address details and then provide your mailing address in Section address Suburb State Postcode Country 2.