Family Member Attestation for Employment Insurance Family Caregiver Benefits or Compassionate Care Benefits - INS5223
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.
Group
Employment Insurance
Forms
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Important Information
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Service Canada (SC)
Family Member Attestation for Employment Insurance (EI) Family Caregiver Benefits or Compassionate Care Benefits
PDF: Download SC-INS5223, 110 KB, printed on 1 pages (8.5 x 11)