Application for Medical Entitlement Statement

I declare that:
• I have provided all relevant documents.
• for the period(s) specified in question 19, I was a resident
of Australia for taxation purposes, and at the same time I
was not eligible for Medicare benefits, nor Medicare
benefits under a Reciprocal Health Care Agreement.
• the information I have provided in this form is complete and
correct.
I understand that:
• information regarding this application is exchanged
between Medicare and the Australian Taxation Office.
• we may contact the Department of Home Affairs to obtain
information relating to my immigration status (if required).
• giving false or misleading information is a serious offence.

Application for Medicare Entitlement Statement

Use this form if you’re claiming an exemption from the Medicare levy and need a statement showing you’re not eligible for Medicare. After submitting this form you will receive an email with a completed MES form and instructions on what to do next.