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.

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

You can apply for a Medicare Entitlement Statement (MES) online using your myGov account.

If you don’t want to complete the MES online form, you can follow these steps:

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

We recommend you email your supporting documents in PDF and make sure they’re not password protected.

If you’re using a tax agent, they need to complete the form, but you need to complete the declaration. Details on how they submit your application are on the 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: 22 November 2022