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.

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 with the Bereavement Declaration. This will include a declaration for your attending doctor or midwife to complete.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 17 June 2024.
QC 20261