Low Income Declaration

Doctors with a medical income in New Zealand or overseas of less than NZ$20,000 per annum may be eligible for a 50% reduction in the InPractice fee.

Please complete the information below to apply for this reduction.

Full Name

Email Address

Medical Council Number

Your Address

Estimate Earnings

Earnings Reason

Declaration

By ticking this box I declare that the information I have given in this application is, to the best of my knowledge, true, complete and correct and that I expect my earnings this year to follow a similar outcome.

Your name

Dated