MORE DOCTORS FOR OUTER METROPOLITAN AREAS MEASURE: RELOCATION INCENTIVE GRANT Application Form Please complete this Application Form in consultation with the Programme Guidelines. . Import Notice The Delegate This form must be completed if you wish to apply More Doctors for Outer Metropolitan for a Relocation Incentive Grant (OMRIG) under Areas Measure the More Doctors for Outer Metropolitan Areas MDP 205 GPO Box 9848 Measure. CANBERRA ACT 2601 Email: outermetro@health.gov.au The can be at: All applications will be acknowledged. http://www.health.gov.au/outermetro Please note: Medicare provider number For advice on the OMRIG or assistance with this information supplied on this form will be checked application, please email: to validate your eligibility for the OMRIG. outermetro@health.gov.au Send Completed applications to: Please answer each question and tick the boxes where appropriate. Please tick the appropriate box before proceeding: Please process this application within 28 days *Tick this box if your relocation is Please hold this application in abeyance until further notice* unconfirmed but you would like in principle approval of this application pending confirmation or submission of further information (eg. If you are undertaking a probation period or if you are a GP Registrar who has not yet obtained Fellowship of the Royal Australian College of General Practitioners). Part 1 PERSONAL INFORMATION (Please Print) Family name First name Postal address
MORE DOCTORS FOR OUTER METROPOLITAN AREAS MEASURE: RELOCATION INCENTIVE GRANT Application Form Please complete this Application Form in consultation with the Programme Guidelines. . Import Notice This form must be completed if you wish to apply for a Relocation Incentive Grant (OMRIG) under the More Doctors for Outer Metropolitan Areas Measure. The can be at: http://www.health.gov.au/outermetro For advice on the OMRIG or assistance with this application, please email: outermetro@health.gov.au Send Completed applications to: The Delegate More Doctors for Outer Metropolitan Areas Measure MDP 205 GPO Box 9848 CANBERRA ACT 2601 Email: outermetro@health.gov.au All applications will be acknowledged. Please note: Medicare provider number information supplied on this form will be checked to validate your eligibility for the OMRIG. Please answer each question and tick the boxes where appropriate. Please tick the appropriate box before proceeding: Please process this application within 28 days Please hold this application in abeyance until further notice* *Tick this box if your relocation is unconfirmed but you would like in principle approval of this application pending confirmation or submission of further information (eg. If you are undertaking a probation period or if you are a GP Registrar who has not yet obtained Fellowship of the Royal Australian College of General Practitioners). Part 1 PERSONAL INFORMATION (Please Print) Family name First name Postal address
OMRIG%20Application%20Form.docx