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, 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: 15 April 2020