Moving Out of Manitoba

Manitoba Health, Seniors and Long-Term Care

Moving out of Manitoba

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

Sex

Date of birth

Street address

City

Province

Postal code

Street address

City

Province/state

Country

Postal code/zip code

Is the new mailing address the same as the new residential address?

Street address

City

Province/state

New Mailing Country

Postal code/zip code

Select a section based on the above criteria

Do you have a spouse or minor children permanently moving with you?

Date of departure from Manitoba

Date of arrival in new place of residence

Spouse or Minor Child's date of departure from Manitoba

Spouse or Minor Child's date of arrival in new place

Select the type of card

Enter the code from the image