Run off Cover Indemnity Scheme - medical certificate permanent disability form (MO056)

Use this form when a Medical Indemnity Insurer or Medical Defence Organisation determines an insured medical practitioner is eligible to participate in the Run off Cover Indemnity Scheme (ROCS) due to permanent disability.

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 Run off Cover Indemnity Scheme - medical certificate permanent disability form.

Use this form if the medical practitioner has temporarily or permanently ceased from providing medical services due to permanent disability.

A medical practitioner other than the medical practitioner being assessed for eligibility under the ROCS must complete this form.

ROCS is the Run off Cover Indemnity Scheme.

Page last updated: 6 December 2024.
QC 44541