Form Profile
Employment Insurance
| Details | |||
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| Number | INS5140 | ||
| Title | Medical Certificate for Employment Insurance Sickness Benefits | ||
| 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. When you apply for sickness benefits, you will be asked to either submit the completed form or keep your completed medical certificate as we may ask you for it later. | ||
| 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 ins5140e.pdf (20 KB) | |||
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For persons with visual impairments, the form is available as: |
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| PDF7 ins5140e_7.pdf (476 KB) | |||
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For more information, please consult the How to Download page. |
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