This form will begin the process of signing up to have Allianz as your plan manager. Refer to our Privacy Notice before completing the form.

All fields marked with an asterisk (*) are required

Tell us a bit about who you are

What best describes you? *

NDIS participant details

What is the participant's date of birth? *
Plan start date
Plan end date

Parent or guardian details

Preference of contact via *

Do you have a copy of guardianship document? (if necessary) *

Is this person also the NDIS plan nominee? *

NDIS Plan Nominee Details

Preference of contact via

Consent to share

Do you want to share additional information with a specific party?

Do you want to add an additional contact? *

Additional contact information

Relationship to participant *

Consent to share

Tick relevant information to share, provide access to and/or disclose

Submit application

Click the Submit box below to continue your request to sign up to Allianz’s NDIS Plan Management. We'll then review your application and one of our dedicated Allianz Plan Managers will be in touch with you within two business days. Nominate below your preferred method of communication. In the meantime, read our draft Service Agreement which we'll discuss with you when we contact you. The draft Service Agreement outlines the services we can deliver and provides options you can choose to meet your needs. You can request changes to the draft Service Agreement.

How would you like one of our plan managers to contact you? *

Privacy Notice

Allianz1 may collect personal information from you and other parties so that we can deal with enquiries in relation to, offer to provide and/or provide or assist you with Allianz NDIS Plan Management services. You can choose not to provide the personal information to us but if you do so, we may not be able to provide some or all of the services to you.

If you provide personal information to us about another party you must have their consent to do so and refer them to our Allianz NDIS Privacy Policy.

In order to provide the services to you, we may disclose your personal information to other parties such as related companies of Allianz, the National Disability Insurance Agency (NDIS), and support and service providers.

In some instances, your personal information may be disclosed and stored overseas. The countries in which these recipients may be located will vary from time to time, but may include Canada, Germany, France, New Zealand, United Kingdom, United States of America, Singapore and India.

Allianz NDIS Privacy Policy contains more information around how we collect, hold and use, and disclosure, your personal information.

When holding your personal information Allianz will comply with the Privacy Act 1988 (Cth), the Australian Privacy Principles (APPs) and any requirements of the National Disability Insurance Scheme Act 2013 (Cth).

Allianz’s NDIS Privacy Policy contains information about:

  • how you may lodge a complaint about a breach of the APPs and how Allianz will deal with such a complaint, and
  • how you may access personal information about you that is held by Allianz and seek correction of that information if incorrect.

1 means Allianz Australia Insurance Limited ABN 15 000 122 850, Level 16, 10 Carrington St, Sydney