Ins5140 2026

1. Click ‘Get Form’ to open the ins5140 in the editor.
2. 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.
3. Fill in your Full Postal Address including Apt. No., Area Code Telephone Number, City or Town, Province/Territory, and Postal Code.
4. Sign the authorization statement at the bottom of Section 1 to allow the release of your medical information to the insurer.
5. Section 2 must be completed by a medical doctor. Ensure they provide their name, specialty, address, and signature along with the expected recovery date.
6. Review all entries for accuracy before saving or printing your completed form.

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