| Details | |
|---|---|
| Number | INS5140 |
| Title | Medical Certificate for Employment Insurance Sickness Benefits |
| Purpose | This form can be completed and signed by a medical practitioner to attest that a patient is unable to work for medical reasons. The person requesting sickness benefits will be asked to either submit this completed form or keep it as it may be required later. |
| Group | Employment Insurance |
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Important Information Returning the Form | |
| Forms |
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|
| Service Canada (SC) |
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Medical Certificate for Employment Insurance Sickness Benefits PDF: SC-INS5140, 132 KB, printed on 1 pages (8.5 x 11) |
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