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.

Page last updated: 27 August 2017