Instructions to assist you to fill in the deed poll form.
These instructions are to assist you to fill in the Deed Poll required to register as a Billing Agent.
You will need to prepare 2 copies of the Deed. You may prepare one copy and photocopy it. You must execute 2 copies – that is, each copy must be signed by the relevant signatory/signatories.
You will keep one executed copy. Please send us the other executed copy to the Medicare eClaiming Programs address on the contact us page, for our records.
1. Insert full details of the Applicant, including full name, full partnership or company name (see below for details) on:
- the front cover
- at the top of page 1 in the description of the parties, and
- the appropriate execution clause at the end of the Deed
If the Applicant is an individual, insert the full name of the individual, for example 'Joe Smith'.
If the Applicant is a small partnership, list the names of all the partners, for example 'Joe Smith and Betty Smith trading as Smith's Electrical'.
If the Applicant is a large partnership, it is acceptable to refer to the partners collectively, for example 'All of the persons carrying on business in partnership in Australia under the name of ABCD'.
If the Applicant is a corporation, insert the full corporation name, for example 'Healthy Company Pty Limited'. Make sure you include the correct version of 'Pty Ltd' as used by the corporation.
Address, ABN and ACN
2. Insert the ABN and ACN (where applicable) of the Applicant on the front page and at the top of page 1 in the description of the parties.
3. Insert the full street address of the Applicant at the top of page 1 in the description of the parties.
Relevant clause 2
4. Choose the appropriate clause from subclauses 2.1, 2.2, 2.3, 2.4 and delete the remainder, for example, if the party is a partnership retain subclause 2.3. Delete the clauses not required by striking through them.
5. Please initial in the margin beside each clause that you strike out.
6. Choose the appropriate execution clause and delete the remaining 3 by striking through them.
7. Please initial in the margin beside each clause that you strike out.
Signing and dating the Deed Poll
8. The Applicant writes the date on the top of page 1 of the Deed Poll and then signs the relevant execution clause at the end of the Deed Poll.
9. Where required, make sure that all persons required to sign for the Applicant do so. For example, if the Applicant is a corporation and has two directors, please ensure that the two directors sign the Deed Poll.
10. Please ensure that all signatures are witnessed.
Applicant keeps one executed Deed Poll
11. The Applicant should retain 1 signed, witnessed and dated copy.
Applicant returns one executed Deed Poll to us
12. The Applicant must return the other signed and dated copy of the Deed to us at Medicare eClaiming Programs. Before doing so, the Applicant should check to ensure it has been properly signed by:
- the applicant personally, if an individual
- each partner, if a partnership OR a partner who has the authority to bind the partnership
- two directors, if it is a corporation or
- one director where it is a sole director proprietary corporation
- the signatures have been witnessed, and
- the Deed is dated on the top of page 1