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Interested in joining? Or simply want to find out more?

Complete your details below and we will contact you to discuss your health insurance needs in more detail and answer any questions you may have.

Click here for the terms and conditions of our special joining offer for netball players and supporters

1. Your details

Title  
First name
required
Surname
required
Email
required
Check this box if you are overseas and do not yet have contact details in New Zealand:  
Eligibility to work in New Zealand:
Are you a New Zealand or Australian citizen or do you hold a resident visa or a work visa valid for at least 2 years?


required
Daytime phone
 
Alternate phone
 
Street address  
Suburb  
Town/city  
Age group  
Number of family members you wish to cover?  
How did you find out about Southern Cross?  
Other (please specify):  

2. What type of cover are you interested in?

Please check the covers are you interested in





 
Are you entitled to a Southern Cross Group Scheme?
required
If yes please enter your Employers name  
Please enter Employers address

  
Please enter your enquiry

  
How would you like us to contact you?
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Before we can take your details please can you ensure you carefully read and confirm your agreement to the Email Privacy - Application Declaration and the Terms of Use. Once you have done so and are happy to proceed please tick the declaration box below.  
 
I confirm that I have read and agree to the terms of the Email Privacy - Application Declaration and the terms of use.
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