Statutory declaration ROCS - Midwife who has ceased practice form (MO041)

Use this form if you are a midwife that has temporarily or permanently ceased midwifery practice because of maternity as at the date a run-off claim was made against you.

Download and complete the Statutory declaration ROCS - Midwife who has ceased practice form.

This statutory declaration should be completed by a midwife on or after the notification date.

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

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: 17 November 2022.
QC 21541