Addition of Spouse

Manitoba Health, Seniors and Long-Term Care

Addition of spouse or common-law partner

This form must be completed by the cardholder of the Registration number that will be shared by the family.

Addition of spouse
Supporting documentation

Cardholder's information

Registration number (six-digit alphanumeric)

Personal Health Identification Number (PHIN - nine digits)

Primary phone number

Email address

Can we contact you at this email address?

Legal first name

Do you have a middle name?

Legal middle name

Legal last name

Please select one

Date of birth

Select either English or French as your official language

Current address

Street address (or PO box number)

City

Province

Postal code

Is your mailing address the same as your current address?

Mailing address

Street address (or PO box number)

City

Province

Postal code

Addition of spouse or common-law partner

Are you adding a spouse or common law partner

Legal first name

Legal middle name

Legal last name

Date of birth

Date of marriage or common-law union

Are you currently a member of the Canadian Armed Forces seeking to register for a Manitoba Health card?

Select your military class

Are you recently released from the Canadian Armed Forces, or will you be released within the next 30 days?

Release date

Do you have a certificate of First Nation Status?

Enter registration number

Select First Nation

Are you an Inuk with an N-number for the Non-Insured Health Benefits (NIHB) program?

Enter N-Number

Does your spouse or common-law partner already have a Manitoba Health Card?

Please select one:

Specify sex

Personal Health Identification Number (PHIN - nine digits)

Former country of residence

Former province of residence

Select either English or French as your official language

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