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 have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.
Page last updated: 7 May 2019