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1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering personal information in the required fields, including your national registry number, last name, first name, date of birth, address, postal code, and municipality.
3. Next, provide details about your employer, including the employer's identification number if known, along with their name and address.
4. Consult with your physician to complete the required medical information, including their name, whether you are unable to work, and the dates of incapacity.
5. Document the reason for your incapacity by indicating the relevant options such as illness, hospitalization, or work-related accident.
6. Ensure that your healthcare provider provides their signature and stamp on the form.
7. Review all the details you have entered for accuracy before proceeding.
8. Once you have completed the form, save your changes. You can also download, print, or share the form directly from the editor.

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