Statutory declaration ROCS - Midwife aged 65 years or older who has ceased practice form (MO039)

Use this form if you were an eligible midwife aged 65 years or older that permanently ceased private practice as a result of a run-off claim being made against you.

Download and complete the Statutory declaration ROCS - Midwife aged 65 years or older who has ceased practice form.

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