This short attestation replaces the full CPP medical report when a patient's condition cannot be cured or adequately treated and is reasonably expected to cause death within six months. It goes with the patient's Terminal Illness Application (ISP-2530A). Service Canada gives these files priority and aims to decide eligibility within 5 business days of receiving a complete application.
The patient completes Section 1 (personal information) and Section 2 (consent to collect information) and writes their SIN on each page. The doctor or nurse practitioner completes and signs Section 3, the attestation itself.
Download the current version from the source each time; forms change without notice.
Terminal Illness Medical Attestation for a Disability Benefits Application Under the Canada Pension Plan
Attestation médicale de maladie en phase terminale pour une demande de prestations d'invalidité en vertu du Régime de pensions du Canada
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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For CPP purposes, a terminal medical condition is a disease state that cannot be cured or adequately treated and is reasonably expected to result in death within six months. By signing, you confirm that definition applies to the best of your knowledge and that the information provided is accurate and complete.
The patient's name, address and identification number, plus your Business Number, GST/HST number or Social Insurance Number for income tax purposes. Service Canada states it cannot process a medical invoice without one of those numbers, so send the invoice with the completed attestation as quickly as possible.
No. The form tells patients not to wait for their doctor or nurse practitioner before sending the Terminal Illness Application, because the date Service Canada receives the application can affect when the benefit starts. A delay in completing the attestation can also affect entitlement for lack of medical information.