Application for a Medicare Entitlement Statement form (MS015)

Use this form if you're not eligible for Medicare and are applying for an exemption from the Medicare levy.

If you have a myGov account, you can complete this online. This is the fastest way to apply. Read how to apply online.

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:

  • each document is less than 5MB
  • all the documents add up to no more than 8MB 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:

  • in PDF format
  • not password protected
  • no larger than 8 MB each.

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: 24 January 2023.