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: 27 August 2017