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 use assistive technology because of a disability or impairment we provide help for assistive technology users of forms.

Page last updated: 27 August 2017