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.

Download and complete the Application for Medicare Entitlement Statement form.

You can use this form if you can’t apply online or are a tax agent. You need to lodge your application from 1 July for the previous financial year.

You can also apply online using your myGov account. Applying online is faster and easier. 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: 11 May 2026.
QC 19486