Please complete the below form to submit your request. Alternatively, you can print and mail in the following form. Click here to download the form Member NumberMember NameContact Details During SuspensionNew Email AddressPlease Note: Email will be the form of communication.New Telephone Details(H)(M)(W)Suspension PeriodsDeparture Date* Date Format: DD slash MM slash YYYY Re-Entry Date* Date Format: DD slash MM slash YYYY Check Lists* E-Ticket Itinery Other (Please Specify Below) Please upload all relevant attachements with your claim...Attach Files Drop files here or I declare that the information that I have provided on this form is true and correct. I understand the terms and information provided, I wish to suspend my membership:Signature*InformationSuspension of membership for overseas travel (contact the Fund for full details)You can apply for 'Suspension of Membership' if you are travelling overseas and will be out of Australia for a continuous period of not less than 2 months to a maximum of 24 months, This will allow you to freeze cover and not have to pay contributions for that period outside of Australia provided all persons listed on that membership will also be travelling for the same period. Your membership will be resumed to the same level of cover prior to your date of travel except for any condition or ailments that arise during the period of suspension which will be treated as pre-existing conditions and the appropriate waiting period apply. Please understand that No Benefit will be considered if the service was incurred during the suspended period. Suspension of a Policy may be granted by CDH Benefits Fund for any other reason and for any other period that CDH Benefits Fund considers appropriate until such time as a further Premium is paid provided that such payments are resumed from the date as directed by CDH Benefits Fund. Further suspension of a Policy will only be granted six months after return of the previous suspension and financially covered for that period. With your request to suspend membership for travel purposes, you must submit supporting documentation for all persons covered on your membership prior to your departure. Documentation includes itineraries and e-tickets. If no evidence of your travel for the period of suspension requested is received, no suspension will be applied to your membership. On returning to Australia you must reinstate your membership within 1 month and pay commencing from the date of return, and supply evidence of the date you returned to Australia. If no evidence is received your suspension will be cancelled and may have Lifetime Health Cover implications. Please understand that any suspended cover may affect your Medicare Levy Surcharge, please contact the Australian Taxation Office (ato.gov.au) for details.NameThis field is for validation purposes and should be left unchanged.