Bereavement Declaration form (FA008M)

Use this form if you are the birth mother or partner of the birth mother, and you want to claim payments for a child who was stillborn or who has recently died.

You must download our forms to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.

The bereavement assistance you get depends on your situation. You can claim the payments online. Read about the payment you may get and what help there is when a child dies.

If you can’t claim online, download and complete the Notes and Claim for Bereavement Payment form.

In cases of stillbirth and infant death, your maternity hospital or registered midwife will give you the Bereavement Declaration. This will include a declaration for your attending doctor or midwife to complete.

Page last updated: 1 July 2025.
QC 20261