Request for a Medicare benefit tax statement form (MS010)

Use this form to request a Medicare benefit tax statement for the financial years 2012-2015.

Download and complete the Request for a Medicare benefit tax statement form.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

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: 10 December 2021