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Number INS3280
Title Appointment of Representative
Purpose Complete this form if you are unable to manage your claim for EI benefits due to health problems. A representative or a public trustee may be appointed to act on your behalf. You can mail or deliver this form to your local Service Canada Centre. Please be sure that you have signed the form or if you are incapable of doing so, that a physician has signed the form.
GroupEmployment Insurance
Important Information
Returning the Form

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Service Canada (SC)

PDF: SC-INS3280, 123 KB, printed on 1 pages (8.5 x 11)

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