Application for a Medicare Entitlement Statement form (MS015)

Use this form if you aren't eligible for Medicare and are applying for an exemption from the Medicare levy.

To complete the form electronically, save a copy of the form before you start filling it in.

Don't forget to print, sign and scan the form before you email it to the Medicare Entitlement Statement Unit.

Page last updated: 7 September 2016

This information was printed Sunday 25 September 2016 from humanservices.gov.au/customer/forms/ms015 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.