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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. Ensure all personal details are accurate for proper identification.
- Fill in your Full Postal Address including Apt. No., Area Code Telephone Number, City or Town, Province/Territory, and Postal Code.
- Sign the authorization statement at the bottom of Section 1 to allow the release of your medical information to the insurer.
- Section 2 must be completed by a medical doctor. Ensure they provide their name, specialty, address, and signature along with the expected recovery date.
- Review all entries for accuracy before saving or printing your completed form.
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