Download and complete the Authorising a person or organisation to act on your behalf - COVID-19 Vaccine Claims Scheme.
If you’re unable to complete this form, you can authorise someone to do it on your behalf. They also need to submit:
- a Authorising a person or organisation to act on your behalf - COVID-19 Vaccine Claims Scheme (MO064)
- a COVID-19 Vaccine Claims Scheme medical report (MO063) completed by your doctor.
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.