Welcome to the Medibank Partner Agent Registration

Thank you for proceeding to the registration page. Please fill all fields below and then click 'continue' to proceed.

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Step 1
Who is registering as an agent?
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Please select one of the following options. If neither option applies, please discontinue this registration process and contact us for more information.

Contact Details
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First Name
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Family Name
Business Name
 
Physical Address
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Address
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Suburb / City
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State
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Postcode
 
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Country
Mailing Address
Copy from Physical Address
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Address
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Suburb / City
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State
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Postcode
 
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Country
 
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ABN
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Phone
 
Mobile
 
Email
Logon Details
Create Username
Create Password
Reenter Password
 
Passwords must be 8-14 characters long and contain at least one letter and one number.
 
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