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Click ‘Get Form’ to open it in the editor.
Begin by entering your contact details. Fill in your provider number, type of services provided, company name, surname, given names, practice address, postal address, phone number, mobile number, and email address for correspondence and e-remittance.
Next, move to the bank account details section. Input the name and address of your bank or financial institution along with the title of your account. Ensure you provide the exact name(s) as they appear on the account.
Fill in your BSB and account number accurately. Review all information for correctness before proceeding.
Sign and date the form to declare that all information is true and correct. Choose your preferred payment frequency by ticking the appropriate box.
Finally, ensure you understand that any changes to bank details require formal written notification.
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