Medical Certificate for Employment Insurance Sickness Benefits - INS5140
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
Forms
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Important Information
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Service Canada (SC)
Medical Certificate for Employment Insurance Sickness Benefits
PDF: Download SC-INS5140, 132 KB, printed on 1 pages (8.5 x 11)