Statutory declaration ROCS - Deceased midwife form (MO040)

Use this form if at the time a claim is made, an eligible midwife is deceased and a valid death certificate is not available to support eligibility under the ROCS provisions of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010.

Download and complete the Statutory declaration ROCS - Deceased midwife form.

Midwife Professional Indemnity Run-off Cover only applies to a claim or incident first notified on or after 1 July 2010.

A claim is taken to be made, on the date on which the midwife’s insurer was first notified of a run-off claim made against the midwife, or an incident that may have given rise to a run-off claim against the midwife.

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