Application to copy or transfer from one Medicare card to another form (MS011)

Complete this form to copy or transfer someone onto your own Medicare card or another Medicare card.

Where the transfer or copy is to another person's Medicare card, that cardholder must also sign the form.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
If you use assistive technology because of a disability or impairment we provide help for assistive technology users of forms.

Page last updated: 14 December 2016

This information was printed Saturday 21 January 2017 from humanservices.gov.au/customer/forms/ms011 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.