Application for a Medicare Entitlement Statement form (MS015)

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

You must save your completed form before emailing it to the Medicare Entitlement Statement team. If you do not save the form before emailing it to us, your details may be lost.

Page last updated: 19 August 2016

This information was printed Thursday 25 August 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.