FORMER POLICE OFFICERS' MEDICAL BENEFIT SCHEME

Claim Form & Medical Certificate

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523 kb


757 kb
 Police Medical Benefit Scheme Claim Form

Police Medical Benefit Scheme Claim Form

The claim form has two parts:

  • Part 1 is to be completed by the former Police Officer and consists of eight sections. Please ensure that all sections are completed to the best of your ability. If the claim is incomplete there may be delays in processing your claim.
  • Part 2 on page 4 of the claim form will be completed by the Western Australia Police.
The PDF Medical Claim Form you print and complete. The Word Medical Claim Form is interactive and can be completed on your computer.




407 kb


1.3 MB
 Police Medical Benefit Scheme Medical Certificate

Police Medical Benefit Scheme Medical Certificate

The Medical Certificate needs to be completed by your treating doctor and submited with your completed claim form.

The PDF Medical Certificate you print and complete. The Word Medical Certificate is interactive and can be completed on your computer.

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