Australian Government medicare Medicare Australia Application for Medicare levy exemption certification The Income Tax Assessment Act 1936 makes the Medicare levy payable by individuals residing in...

Australian Government medicare Medicare Australia Application for Medicare levy exemption certification The Income Tax Assessment Act 1936 makes the Medicare levy payable by individuals residing in Australia who are eligible for Medicare. Persons who are not entitled to Medicare can seek an exemption from the Medicare levy in their income tax return. To obtain an exemption, you (and your dependants) must be ineligible for Medicare and must apply for Medicare levy exemption certification. Eligibility • To check your eligibility for Medicare benefits, call the Medicare Levy Exemption Certification Unit on XXXXXXXXXX". • You may not be eligible for an exemption certificate if you: - hold an Australian permanent resident visa or have applied for a permanent resident visa - were a resident of the United Kingdom, Northern Ireland, Italy, Malta, Sweden, the Netherlands, Finland or Norway prior to entering Australia - maintain a dependant or other person(s) who was eligible for Medicare (an applicant maintains a dependant if any of the following applies—the applicant and their dependant live in the same house; the applicant provides the dependant with food, clothing and lodging; the applicant helps the dependant pay for their living, medical and educational costs.) - are an Australian citizen, residing overseas for less than five years. (Note: this includes Australian government officers.) • You should not apply for certification for the current financial year unless you are leaving the country and will be submitting a final income tax return before the end of the financial year. To claim an exemption • To claim an exemption from the Medicare levy in your income tax return, you need to supply a copy of your Medicare levy exemption certification. To obtain this certification, you must complete this application form and submit it to Medicare Australia. • When we have assessed and processed your application, we will send you the certificate, or a response which details the reason your certification was refused. • We require certified copies of all used pages of your passport. This includes all Australian visas, all arrival and departure stamps and the photo page. • We require a separate application form for each financial year. (A financial year runs from 1 July to 30 June). • We require an original dated signature on each application form. • If a tax agent prepares the application, the tax agent must complete the Tax Agent details under question 12 of the application form. • For more copies of this form visit www.medicareaustralia.gov.au then go to Medicare forms - individuals then go to Medicare claiming forms or call XXXXXXXXXX*. Lodgement details Post your completed application form to: Levy Exemption Certification Unit Medicare Australia GPO Box 9822 Hobart TAS 7001 * Call charges apply Enquiries If you need help completing this form call the Medicare Levy Exemption Certification Unit on XXXXXXXXXX* or email your enquiry to XXXXXXXXXX Queries about deductions of the Medicare levy from salary or wages should be directed to the Australian Tax Office. Application for Medicare levy exemption certification You must answer all questions. Print neatly in BLOCK LETTERS. Tick where applicable !NI 1 Which financial year are you applying for? 1 July 20 to 30 June 20 Note: you must make a separate application for each financial year you are applying for. Your details Show exactly as it will appear on your income tax return. Dr Mr Mrs Other (please specify) 2 Family name Miss Ms First given name Second given name 3 Date of birth / / 4 Your sex Male Female 5 Phone number XXXXXXXXXXYour permanent address This cannot be a PO Box address. A business address is not acceptable unless you are living at the business address. Postcode Country (if not Australia) Page 1 of XXXXXXXXXX