Bank account details collection form (MS013)

Use this form to register and store your bank account details with us.

We will use these details for all Medicare payments where you paid for the service.

Other people listed on your Medicare card, 14 years of age and over, can use this form to consent to use your bank account for their Medicare payments.

 
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: 9 April 2018