Statutory declaration ROCS - midwife who has ceased practice form (MO041)

Use this form if you are a midwife that has temporarily or permanently ceased midwifery practice because of maternity as at the date a run-off claim was made against you.

This statutory declaration should be completed by a midwife on or after the notification date.

Midwife Professional Indemnity Run-off Cover only applies to a claim or incident first notified on or after 1 July 2010.

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.
This information was printed Sunday 26 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/mo041 It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 10 April 2019