Statutory Declaration Run-off Cover Indemnity Scheme – Deceased Midwife form (MO040)

This statutory declaration should be completed where, at the time a claim is made, the person who had been an eligible midwife is deceased and a valid death certificate is not available to support eligibility under the Run-off Cover provisions of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 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. Midwife Professional Indemnity Run-off Cover only applies to a claim or incident first notified on or after 1 July 2010.

Page last updated: 8 June 2016

This information was printed Friday 30 September 2016 from humanservices.gov.au/health-professionals/forms/mo040 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.