Application to copy or transfer from one Medicare card to another form (MS011)

Complete this form to copy or transfer someone onto your own Medicare card or another Medicare card.

Download and complete the Application to copy or transfer from one Medicare card to another form.

When the transfer or copy is to another person's Medicare card, that cardholder must also sign the form.

You can submit your form and your supporting documents to us by mail or email to Medicare Enrolment Services. To help us process your request please include Copy or transfer in the subject line. You don’t need to get your supporting document certified.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 1 September 2020