Run off Cover Indemnity Scheme - medical certificate permanent disability form (MO056)

Use this form when a Medical Indemnity Insurer or Medical Defence Organisation determines an insured medical practitioner is eligible to participate in the Run off Cover Indemnity Scheme (ROCS) due to permanent disability.

Run off Cover Indemnity Scheme - medical certificate permanent disability form

Use this form if the medical practitioner has temporarily or permanently ceased from providing medical services due to permanent disability.

A medical practitioner other than the medical practitioner being assessed for eligibility under the ROCS must complete this form.

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: 14 November 2018

Was this page useful?
Why?
Why not?

Thank you for your feedback.