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Details
Number INS5223
Title Family Member Attestation for Employment Insurance Family Caregiver Benefits or Compassionate Care Benefits
Purpose Complete this form and have it signed by the gravely ill or critically ill or injured person that considers you “like” a family member. This form should accompany your claim for Compassionate Care or Family Caregiver benefits. You can also mail or deliver the form to your local Service Canada Centre.
GroupEmployment Insurance
Important Information
Returning the Form

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Service Canada (SC)

Family Member Attestation for Employment Insurance Family Caregiver Benefits or Compassionate Care Benefits
PDF: SC-INS5223, 108 KB, printed on 1 pages (8.5 x 11)

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