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Fillable Printable Medicine export declaration - Australia

Fillable Printable Medicine export declaration - Australia

Medicine export declaration - Australia

Medicine export declaration - Australia

Page 1 of 2 2619.12.01.10
Important information
Complete this declaration if you are taking or sending medicines out of
Australia.You must include this declaration with the medicines being
taken or sent out of Australia.
You may leave Australia carrying the following medicines:
non-prescription medicine (e.g. over-the-counter) a)
prescription medicine where no Pharmaceutical Benefits b)
Scheme (PBS)
subsidy
has been paid or is payable for the
medicine
prescription medicine for your personal use or for the person c)
travelling with you (e.g. child).
It is your responsibility to show that the medicine being exported fits
into one of the above categories.You will need to provide evidence
to the Australian Customs Service that your medicine fits into one of
these categories. If you are unable to obtain a letter from your doctor or
pharmacist, this declaration may be sufficient.
Exporting medicines
An exporter under the National Health Act 1953 is a person who either
leaves Australia taking drug like substances, or consigns for export an
article containing such substances.
It is illegal to take or send PBS medicines overseas unless it is for the
personal use of the exporter, or somebody travelling from Australia
with the exporter.
The impact of illegal export of PBS medicines
on Australia
Under the PBS, the Australian Government subsidises the cost of
around 2500 prescription medicines. In most cases patients pay only
a small contribution, sometimes nothing at all, towards the full cost
of a PBS medicine.
Exporting PBS subsidised medicines to people outside Australia
leads to a significant financial loss to both taxpayers and the
Australian Government. It is also dangerous for people to take
prescription medicine that has not been prescribed for them.
Offences
Under Section 103 of the National Health Act 1953 the maximum
penalty for a person using, disposing or otherwise dealing with a PBS
medicine that has been prescribed for or supplied to them, in a way
other than which it was meant, is two years imprisonment and/or
a $5000 fine.
It is also an offence to export more than the designated quantity of
a PBS medicine unless that quantity was supplied by an approved
supplier for the medical or dental treatment of the exporter, or the
exporter has some other cause for possessing or consigning for export
that amount of the medicine.
The maximum penalty for a person exporting above the
designated quantity of a PBS medicine is two years imprisonment.
The designated quantity is calculated using a formula set out in the
National Health Act 1953.
Medicine export declaration
What is the correct way to take or send PBS
subsidised medicine overseas?
You must keep all medicines in original packaging. In the case of
prescription medicine, the label on the packaging must show where
the medicine was dispensed, for whom the medicine was prescribed
and how much was paid for the medicine.
You should also contact the embassy or high commission of the
destination country to ensure the medicine is legally able to enter
that country.
Giving false or misleading information is a serious offence
(Criminal Code Act 1955, Section 137.1).
Assistance
If you need assistance completing this form call 1800 500 147
(call charges may apply). For more information about
exporting medicines go to www.medicareaustralia.gov.au>
For Individuals and Families >Migrants and travellers >
Travelling overseas >Taking and sending PBS medicines
Print in BLOCK LETTERS
Tick where applicable
Page 2 of 2 2619.12.01.10
Your details
Full name1
Address2
Postcode
Phone number3
( )
Mobile phone number
( )
Email4
@
Medicine being exported
The medicine I am taking/sending out of Australia is:5
Tick all that apply.
Non prescription medicine
Prescription medicine that has not been subsidised by PBS
PBS subsidised medicine for my personal use
PBS subsidised medicine for a person travelling in my company
Full name of the person for whom the medicine was prescribed 6
for (if applicable)
Names of medicine (including strength, quantity, daily dose)7
Exportation details
I am:8
Taking PBS medicine overseas Go to 9
Sending PBS medicine overseas
Go to 10
Passport number
9
Passport country of issue
Flight number
Destination
Expected length of stay outside Australia
Full name of person PBS medicine is being sent to10
Address11
Postcode
Your relationship to the recipient of medication 12
Reason for sending PBS medicines overseas13
Doctor’s details
Full name of the doctor who prescribed the prescription medicine14
Address15
Postcode
Pharmacist’s details
Full name of pharmacist and/or pharmacy that supplied the 16
prescription medicine
Address17
Postcode
Declaration
I declare that:18
the information on this form is correct.•
Exporter’s signature
-
Date
/ /
Privacy note
The information on this declaration is collected for the purpose of
detecting and investigating breaches of the National Health Act 1953.
We will not disclose this information to a third party unless authorised
or required by law.
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