Annual Charge Waiver or Refund for ARTG Entries Subject to Reclassification

Closes 30 Jun 2029

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Declaration

1. I declare that: I am the person in relation to whom the medical devices are included in the ARTG for the purposes of this form. OR I am authorised to act on behalf of the person in relation to whom the medical devices are included in the ARTG for the purposes of this form (for instance, the agent). The information provided in this form is to the best of my knowledge, complete, current and correct. Providing information that is false or misleading to a Commonwealth entity or in connection with a Commonwealth law is a serious offence subject to criminal penalties under the Criminal Code Act 1995.
Date (Required)

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