Transfer Application Accredited Membership

ATMS TRANSFER APPLICATION
Personal Details
Please attach photo*

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Please attach one of the following as a form of identification (Driver's License, Birth Certificate, or Passport)*

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Name

PrefixFirst NameSurname Name
Postal Address

Street Address

Street Address Line 2

SuburbState

Postcode
E-mail:*
Home Telephone (for ATMS office use only)
Mobile:
Birth Date:

DayMonthYear
Country of Birth
Statutory Declaration for Transferring Members for non-related Health Fund modalities only (Alternative to providing certified copies of the transcript and testamur)*

I confirm that I am and have been an accredited member of the association from which I am transferring.I confirm that at the time of joining the association referred to above, I provided certified copies of my testamur/certificate and transcript as required to confirm my qualifications.
Please attach certified copies of all qualifications.

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Please attach Provide FIRST AID*

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Please attach PROFESSIONAL INDEMNITY policy*

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Please attach Copy of current association membership.*

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ATMS TRANSFER APPLICATION