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Application fee:

Registration fee:

Amount payable:

$20

+

$150

=

$170

ASGR-40

SECTION I: Payment

You are required to pay both an application fee and a registration fee.

Your required payment is detailed below: Use the table below to select your application fee and registration fee.

*ASGR-40*

Applicants must pay 100% of the stated fees at the time of submitting the application.

Registration period

The annual registration period for the nursing and midwifery professions is between 1 June and 31 May. If your application is made between 1 April and 31 May this year, you will be registered until 31 May next year.

Refund rules The application fee is non-refundable. The registration fee will be refunded if the application is not approved.

21. How are you paying your fees? Mark one box below only

Payment by cheque, money order or bank draft must be in Australian currency, drawn on an Australian bank.

Visa or MasterCard Complete credit/debit card payment slip below

Cheque/Money order/Bank draft

Cash/EFTPOS (only available if paying in person)

A receipt will be provided.

You must attach cheque or money order payable to the Australian Health Practitioner Regulation Agency.

On the back of the cheque, money order or bank draft, you must write:

  • your full name

  • your date of birth, and

  • your AHPRA registration number (if you have one).

Please post this form with payment and required attachments to:

AHPRA GPO Box 9958

IN YOUR CAPITAL CITY (refer below)

You may contact AHPRA on 1300 419 495 or you can lodge an enquiry at www.ahpra.gov.au

Sydney NSW 2001 Adelaide SA 5001

Canberra ACT 2601 Perth WA 6001

Melbourne VIC 3001 Hobart TAS 7001

Brisbane QLD 4001 Darwin NT 0801

Credit/Debit card payment slip – please fill out

Amount payable

Name on card

$

Cardholder’s signature

Visa or MasterCard number

Expiry date

SIGN HERE

MM / Y Y

Effective from: 9 September 2014

Page 8 of 9

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