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

Legal middle name

Legal last name

Sex

Date of birth

Apartment/unit number

Street address

City

Province

Postal code

Please select the option that best describes the applicant's situation

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