COVID-19 Vaccine Claims Scheme cost calculation form (MO065)

Use this form to outline losses or expenses if you’re making a claim made under the COVID-19 Vaccine Claims Scheme.

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 or need an interpreter.

Download and complete the COVID-19 Vaccine Claims Scheme expenses form.

Before you complete this form, you must check:

Find out more about the COVID-19 Vaccine Claims Scheme.

Page last updated: 2 April 2023.
QC 62401