COVID-19 Vaccine Claims Scheme Application form (MO062)

Use this form to apply for compensation under the COVID-19 Vaccine Claims Scheme.

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:

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

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 use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 9 April 2022