Statutory declaration ROCS - Deceased midwife form (MO040)

Use this form to declare for the Midwife Professional Indemnity Run-Off Cover Scheme (MPIROCS) that an eligible midwife is deceased and a valid death certificate isn’t available.

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.

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

The MPIROCS only applies to claims or incidents first notified on or after 1 July 2010.

Page last updated: 1 July 2025.
QC 21506