Approved supplier manual payment reconciliation form (PB242)
Use this form if you are an approved supplier manually claiming or reconciling a payment for supplying PBS items or highly specialised drugs, or both.
Download and complete either the Word or PDF version of the:
- Approved supplier manual payment reconciliation form
- Approved supplier manual payment reconciliation form.
If you close your claim electronically, you do not need to use this form.
We require you to keep a copy of the completed form that you submit to us for your records.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.
Page last updated: 17 February 2020