Claim and Notes for Bereavement Payment form (FA008M)

Use this form if you are the birth mother or partner of the birth mother and you want to claim payments for a child who was stillborn or who has recently died.

This form contains 2 sections - notes and claim form.

In cases of stillbirth and infant death, your maternity hospital or registered midwife will provide you with a different version of this form, which will include a declaration for your attending doctor or midwife to complete.

If you use assistive technology because of a disability or impairment we provide help for assistive technology users of forms.

Page last updated: 9 April 2018