Employment Insurance

Medical Certificate for Employment Insurance Sickness Benefits
Number	INS5140
Details	File Size: 21 k	Page Count: 1	Paper Size: 8.5x11
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. You can mail or deliver this form to your local Service Canada Centre. Please note that the fees requested by your doctor to complete this form are entirely at your own expense.
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