Follow the steps to complete your AU MASS84 form.

1. Click the ‘Get Form’ button to obtain the AU MASS84 form and open it for editing.
2. Enter your family name in the designated field to identify yourself clearly.
3. Provide your given name(s) in the respective field beneath the family name.
4. Fill in your date of birth using the format requested on the form. This information is crucial for verifying your identity.
5. Select your gender by checking the appropriate box: Male (☐ M), Female (☐ F), or Indeterminate (☐ I).
6. Indicate the type of concession card you hold by checking one of the following: Centrelink Health Care Card, Centrelink Pensioner Concession Card, or Department of Veterans’ Affairs Card.
7. Provide your Concession Card Number in the corresponding field to further verify your eligibility.
8. Enter the Issue Date on your card as shown, typically placed on the card itself.
9. Write the Name of the Card Holder as it appears on your concession card.
10. Fill in the Expiry Date on the card for verification purposes.
11. Input your Address on the card to provide accurate contact information.
12. Authorise the Medical Aids Subsidy Scheme (MASS) by signing your name in the designated area.
13. Date your signature to confirm the timing of your consent.
14. If applicable, indicate whether the card holder or a customer representative is signing by checking the appropriate box. If a representative is signing, provide their name and type of representative role.
15. Attach any necessary evidence confirming the authority of a customer representative, such as a copy of an Enduring Power of Attorney.
16. Once the form is completed, you can save changes, download a copy, or print the form for submission.

Complete your AU MASS84 form online today to access the Medical Aids Subsidy Scheme services.