Claim for Bereavement Payment Form

This form contains two sections - notes and claim form. This form is used if you are claiming Parental Leave Pay, Baby Bonus, Maternity Immunisation Allowance and/or Family Tax Benefit for a child you are not already receiving payment for who has recently died.

In cases of stillbirth and infant death, your maternity hospital or registered midwife will provide you with a different version of this form, which will include a declaration for your attending doctor or midwife to complete.

• Claim for Bereavement Payment [Form, 59 pages, PDF: 486KB]

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