Application to register as an Approved Billing Agent and ECLIPSE form (HW015)

Use this form to register as an Approved Billing Agent, and to participate in Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE).

You must submit this form with all of the required documents as outlined in the billing agent registration process.

ECLIPSE is the Electronic Claim Lodgement and Information Processing Service Environment.

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: 26 November 2018

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