Form Profile
Employment Insurance
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| Number | INS5216 | ||
| Title | Medical Certificate for Employment Insurance Compassionate Care Benefits | ||
| Purpose | Have this form completed by a medical doctor if you are asking for compassionate care benefits. You can return this form by mail or deliver it 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. | ||
| Language | English | ||
| Paper Size | 8.5x11 | ||
| Returning the Form |
Important Information
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| Forms | |||
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You can view this form in: |
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| PDF5 ins5216e.pdf (89 KB) | |||
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For persons with visual impairments, the form is available as: |
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| PDF7 ins5216e_7.pdf (447 KB) | |||
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For more information, please consult the How to Download page. |
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