Statutory declaration ROCS - Deceased midwife form (MO040)

Use this form if at the time a claim is made, an eligible midwife is deceased and a valid death certificate is not available to support eligibility under the ROCS provisions of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010.

Download and complete the Statutory declaration ROCS - Deceased midwife form.

Midwife Professional Indemnity Run-off Cover only applies to a claim or incident first notified on or after 1 July 2010.

A claim is taken to be made, on the date on which the midwife’s insurer was first notified of a run-off claim made against the midwife, or an incident that may have given rise to a run-off claim against the midwife.

ROCS is the Run-off Cover Indemnity Scheme.

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 contact us. We can help you access, complete and submit them.

Page last updated: 7 July 2020