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Application for Medicare Entitlement Statement

    Do you have a current or expired Medicare card?*
    NoYes

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    -
    Ref:


    Residential Address*





    Postal Address*





    Is the postal address a tax agent’s address?

    NoYes

    How long did you live in this country before coming to Australia?*

    Do you hold current or expired health or medical insurance in Belgium, Italy, the Netherlands, Norway or Slovenia (for example European Health Insurance card, Tessera Sanitaria or AIRE registration)?*
    NoYes

    Are you from Finland, Malta or Norway?*
    NoYes

    Did you enter Australia on a student visa?*
    NoYes

    Have you lodged an application for permanent residency (other than a parent visa) with the Department of Home Affairs, this includes applications for Spouse Combined visas (subclass 820/801) and (subclass 309/100)?*
    NoYes


    Is the application for permanent residency that is being considered by the Department of Home Affairs, still ongoing?*
    YesNo

    Have you lodged an appeal against that decision?*
    NoYes



    Have you lodged more than one Permanent residency application?*
    NoYes


    Is the application for permanent residency that is being considered by the Department of Home Affairs, still ongoing?*
    YesNo

    Have you lodged an appeal against that decision?*
    NoYes



    Have you lodged an application for permanent residency with the Department of Home Affairs under parent category (Aged parent or Contributory parent)?*
    NoYes

    Aged parentContributory parent

    Are you leaving Australia permanently before end of the current financial year?*
    NoYes