Statutory declaration ROCS - Deceased medical practitioner form (MO033)

Use this form if you need to declare for the purpose of ROCS where a valid death certificate is not available to support eligibility.

Download and complete the Statutory declaration ROCS - Deceased medical practitioner form.

The ROCS only applies to claims or incidents first notified on or after 1 July 2004.

ROCS is the Run off Cover Indemnity Scheme.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

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 contact us. We can help you access, complete and submit them.

Page last updated: 3 March 2022