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.
Before they complete this form, check if you’re eligible under the scheme and what proof you need. Find out more about the COVID-19 Vaccine Claims Scheme.
To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.
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.