Police Welfare Fund Newborn Form

Health Plan

Use this form to claim Police Health Plan and Police Welfare Fund Birth Benefits, and PWF adoption benefits.

You can also use this form to sign your newborn up to Police Health Plan.

You can scan and email the completed form, along with any copies of birth certificates, notices and receipts, to enquiries@policeassn.org.nz

You can print a blank claim form and complete, or edit the claim form online.

Make sure you have Adobe Acrobat Reader downloaded (not Adobe Preview). Download Adobe Acrobat Reader

To use the editable form, please:

1. Open the 'editable online' pdf  using either Chrome or Internet Explorer internet browsers for optimal results.

2. SAVE it to your computer before you complete the form.

3. Complete the form and save again, then send the completed form to us (see details below).

When emailing forms, documents or pictures:
Please use the attachment function to attach your jpeg, png or PDF to your email. Do not insert them into your email as this will delay processing.