Application for a Medicare Entitlement Statement form (MS015)

Use this form if you're claiming an exemption from the Medicare levy and need a statement showing you’re not eligible for Medicare.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

Download and complete the Application for Medicare Entitlement Statement form.

You can also apply online using your myGov account. Read more about applying online for a Medicare Entitlement Statement.

Make sure your supporting documents are:

  • clear and show all the information
  • in PDF, JPG, PNG, GIF or BMP format
  • not password protected or in a WinZip or RAR file
  • less than 5MB each
  • less than10 MB in total.

If they’re password protected, we can’t access them.

Page last updated: 19 September 2024.
QC 19486