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Get Canada SC INS3280 E 2008

Cial Insurance Number Address CLAIMANT PART 1 APPOINTMENT OF REPRESENTATIVE I, being at present unable to conduct business on my (NAME OF CLAIMANT) own behalf by reason of illness, injury or quarantine, hereby appoint to be my agent and representative for the purpose of claiming and receiving on my behalf, any employment insurance benefit to which l may be entitled during the period of my disability. FIRST WITNESS (To be witnessed by a person other than the representative.) DATE SIGNATU.

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