You must download our forms to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.
Download and complete the Authorising a person or organisation to act on your behalf - COVID-19 Vaccine Claims Scheme.
If you’re unable to complete this form, you can authorise someone to do it on your behalf. They also need to submit:
- a Authorising a person or organisation to act on your behalf - COVID-19 Vaccine Claims Scheme (MO064)
- a COVID-19 Vaccine Claims Scheme medical report (MO063) completed by your doctor.
Before they complete this form, check if you’re eligible under the scheme and what proof you need. Find out more about the COVID-19 Vaccine Claims Scheme.