Medical Certificate for Employment Insurance Sickness Benefits

About this form

Medical certificate required when applying for EI sickness benefits. Completed by a physician to confirm the applicant is unable to work due to illness.

Medical certificate required when applying for EI sickness benefits. Completed by a physician to confirm the applicant is unable to work due to illness.

Who needs this form

Employed individuals who need to apply for EI sickness benefits due to illness or injury

What's in this form

• Patient information
• Diagnosis and medical condition
• Period of inability to work
• Expected date of recovery
• Physician information and signature

Published by

Service Canada