Addition of Spouse

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Manitoba Health, Seniors and Long-Term Care

Addition of spouse or common-law partner

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 you and/or your child(ren) for a Manitoba health card?

Enter your National Defence Identification Card number

*

Select your military class

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)

*

Date of arrival

*

Former country of residence

Former province of residence

Select either English or French as your official language

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