|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.|
Returning the Form
|Service Canada (SC)|
Family Member Attestation for Employment Insurance (EI) Family Caregiver Benefits or Compassionate Care Benefits
PDF: SC-INS5223, 110 KB, printed on 1 pages (8.5 x 11)
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