TAC letterhead · Web viewCancellation of Independent Medical Examiner (IME) Doctor Name: (Please...

Cancellaon of Independent Medical Examiner (IME) Doctor Name: (Please ck) 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) aﬅer 31 March 2018. Signed: Signatory Name: Date: Send To: Post: Aenon: Jacinta Zurcas Health Branch Transport Accident Commission Po Box 742 GEELONG VIC 3200 Email: Aenon: Jacinta Zurcas [email protected]

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Transcript of TAC letterhead · Web viewCancellation of Independent Medical Examiner (IME) Doctor Name: (Please...

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]