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.

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. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 27 August 2017