Statutory declaration ROCS - midwife aged 65 years or older who has ceased practice form (MO039)

Use this form if you were an eligible midwife aged 65 years or older that permanently ceased private practice as a result of a run-off claim being made against you.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 10 April 2019

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