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.

The fastest and easiest way to apply for a statement is online using the Individual Healthcare Identifiers (IHI) service through myGov.

If you can’t apply online through the IHI service, download and complete the form.

Downloading and completing a PDF form digitally

If you want to complete this form digitally you need to download it and save it to your computer before you start filling it in.

You need Adobe Acrobat Reader to complete this form digitally. If you don’t already have this on your computer, Adobe Acrobat Reader is free to download.

Follow these steps to complete the form:

When you upload your documents, make sure they’re:

  • clear and show all the information
  • in PDF, JPG, PNG, GIF or BMP format
  • less than 5MB each
  • less than 10MB in total.

If you upload PDFs, make sure they’re not password protected.

Printing a paper version of the form

If you can’t complete the form digitally, you can print it and complete it by hand.

You can then upload it to myGov with your supporting documents.

If you can’t upload the documents to myGov, you can either:

If you email your form, check your 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.

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: 5 June 2023.
QC 19486