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Manitoba Health, Seniors and Long-Term Care
Manitoba.ca
>
Health
>
Manitoba Health Card and Coverage
Common-law union declaration
Common-law
Supporting documentation
Spouse to be primary cardholder
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?
Yes
No
Legal first name
*
*
Do you have a middle name?
*
Yes
No
Legal middle name
*
Legal last name
*
*
Date of birth
*
*
Spouse to be recognized as common-law partner
Registration number (six-digit alphanumeric)
*
Personal Health Identification Number (PHIN)
*
*
Primary phone number
*
Email address
*
*
Legal first name
*
*
Legal middle name
*
Legal last name
*
*
Date of birth
*
*
Select the type of card
*
Plastic
Digital
Both
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