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Ins5140 2026
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- Click ‘Get Form’ to open the ins5140 in the editor.
- In Section 1, enter your Social Insurance Number, Date of Birth, Last Name, First Name, and Initials. Fill in your Full Postal Address including Apt. No., Area Code Telephone Number, City or Town, Province/Territory, and Postal Code.
- Sign the form as the claimant or representative to authorize the release of information regarding your illness or pregnancy.
- Proceed to Section 2 where a medical doctor must complete details about your incapacity. They will need to provide dates related to your medical condition and expected recovery date.
- Ensure that the medical practitioner fills in their name, specialty, address, and signature along with their contact number and date.
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