Statutory declaration - Midwife Professional Indemnity Scheme - Online claim form (MO042)

Use this form to support a Midwife Professional Indemnity Scheme (MPIS) online claim application.

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 - Midwife Professional Indemnity Scheme - Online claim form.

A person authorised to represent your organisation must complete and sign this form.

If the statutory declaration is not provided with each new online claim application a Commonwealth Contribution Indemnity Scheme payment cannot be made.

Page last updated: 1 January 2025.
QC 21491