Medical Indemnity Protection Society Limited

Update Your Details

As a MIPS member it is vital that you keep your details up-to-date. This includes:

address and other contact information
changes to your gross private income
the kind of work you do.

Please complete the following online form or contact Membership Services directly on 1800 061 113.

What are you telling us about?

	Change of contact details
	Change of category (please provide details in the Further Information field)
	Change to Gross Private Income (please provide details in the Further Information field)
	Other change (please provide details in the Further Information field)

Further information:

*Denotes Mandatory Field

When will these changes take effect? *
Membership number: *
Surname: *
First name(s): *
Date of Birth: (DD/MM/YYYY)*
Email Address: *

Address/Contact Change

New Details

Address line 1:
Address line 2:
City:
State:
Country:
Postcode:
Private Phone:
Practice Phone 1:
Practice Phone 2:
Mobile:
Email:

	Events
	Incident Form
	Government Schemes
	Delegation of Authority
	Practice Staff

Medical Indemnity Protection Society Ltd (MIPS) is an Australian Financial Services Licensee (AFS Lic. 301912). MIPS Insurance Pty Ltd (MIPS Insurance) is a wholly owned subsidiary of MIPS and holds an authority issued by APRA to conduct general Insurance business and is an Australian Financial Services Licensee (AFS Lic. 247301). MIPS has a binding authority from MIPS Insurance to issue the MIPS Insurance medical indemnity policy. Any financial product advice is of a general nature and not personal or specific.