Form CA 5 Claim for Compensaion by Widow, Widower, and or Children 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of the deceased employee in the first field. Ensure you include their last, first, and middle names.
3. Fill in the date of birth of the deceased employee. Use the format (Mo., day, year) for accuracy.
4. Provide the date of death in the specified format. This is crucial for processing your claim.
5. Complete sections regarding your relationship to the deceased, including your own date of birth and marriage details.
6. List all children who may be entitled to compensation, ensuring you include their names, relationships, and dates of birth.
7. Review all entries for accuracy. If any item does not apply to you, indicate this by writing 'NA'.
8. Once completed, save your form and utilize our platform's signing feature to sign electronically before submission.

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