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Cancellation of Independent Medical Examiner (IME)
Doctor Name:
(Please tick)
I do not wish extend my approval as an Independent Medical Examiner (IME), and am aware that I will no longer be able to provide IME services for the Transport Accident Commission (TAC) after 31 March 2018.
Signed:
Signatory Name:
Date:
Send To:
Post:Attention: Jacinta ZurcasHealth Branch Transport Accident CommissionPo Box 742GEELONG VIC 3200
Email: Attention: Jacinta [email protected]
