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Number INS5168
Title Maternity and/or Parental benefits Annex 3
Purpose Complete this form if you are applying for maternity and/or parental benefits under the Employment Insurance Act. You can mail or deliver this form to your local Service Canada Centre. Please be sure that you have answered all the questions pertaining to your situation. Finally, be sure to date and sign the form.
GroupEmployment Insurance
Important Information
Returning the Form

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Service Canada (SC)

Maternity and/or Parental benefits Annex 3
PDF: SC-INS5168, 228 KB, printed on 3 pages (8.5x14)

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