Statutory Declaration Midwife Professional Indemnity Scheme – Online claim form (MO042)

This statutory declaration must be completed and signed by a person authorised to represent your organisation and must accompany the supporting documentation provided for a Midwife Professional Indemnity Scheme (MPIS) online claim application. If the statutory declaration is not provided with each new online claim application a Commonwealth Contribution Indemnity Scheme payment cannot be made.

 

Page last updated: 8 June 2016

This information was printed Friday 30 September 2016 from humanservices.gov.au/health-professionals/forms/mo042 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.