Authorising a person or organisation to act on your behalf - COVID-19 Vaccine Claims Scheme form (MO064)

Use this form to authorise a person or organisation to make a claim under the COVID-19 Vaccine Claims Scheme on your behalf.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

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:

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.

Page last updated: 2 April 2023.
QC 55978