Before you complete this form, check if you or the person you’re claiming for are eligible under the scheme and what proof you need. Find out more about the COVID-19 Vaccine Claims Scheme.
Download and complete the COVID-19 Vaccine Claims Scheme application.
You can submit a claim for yourself or someone you’re authorised to represent.
You need to also submit:
- a COVID-19 Vaccine Claims Scheme medical report (MO063)
- a Authorising a person or organisation to act on your behalf - COVID-19 Vaccine Claims Scheme (MO064) - only if you’re making the claim on someone else’s behalf.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
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