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Number INS5140
Title Medical Certificate for Employment Insurance Sickness Benefits
Purpose Have this form completed by a medical doctor or other health practitioner acceptable to the Commission if you are unable to work due to illness, injury or quarantine. When you apply for sickness benefits, you will be asked to either submit the completed form or keep your completed medical certificate as we may ask you for it later.
GroupEmployment Insurance
Important Information
Returning the Form

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Service Canada (SC)

MEDICAL CERTIFICATE FOR EMPLOYMENT INSURANCE SICKNESS BENEFITS
PDF: SC-INS5140, 138 KB, printed on 1 pages (8.5 x 11)

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