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.

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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