Authorisation to act on an incapacitated person's behalf for 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling in the Medicare customer’s details, including their Medicare card number, name, gender, date of birth, and permanent address. Ensure you use black or blue pen and print in BLOCK LETTERS.
  3. Next, provide your details as the authorised representative. Include your name, date of birth, relationship to the customer, and both permanent and postal addresses if they differ.
  4. Complete the obligations section by agreeing to the responsibilities outlined. Sign and date this section to confirm your acceptance.
  5. Attach all required documents: proof of identification, a statutory declaration regarding your relationship, evidence of a similar arrangement, and documentation proving the customer's inability to manage their affairs.
  6. Review all fields for completeness before returning your form either in person or by post to the Department of Human Services.

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