Sworn Statements and Declaration of Domicile
To register or re-register for health insurance, you may need to provide additional information to confirm your situation (domicile, duration of stay in Québec, dependants, etc.). On this page, you will find our sworn statement and declaration of domicile forms.
Forms
- Sworn Statement: This form confirms information concerning your situation and presence in Québec: duration of your stay, your intention to settle in Québec, your marital status. It must be signed before a commissioner for oaths.
- Sworn Statement – Proof of Residence: This form confirms your place of residence or that of your family if there is no official document. It must be completed and signed before a commissioner for oaths by the owner, its representative or the tenant who signed the lease.
- Sworn Statement – Presence in Québec and Identification of a Child: This form confirms the intention of the parent or legal guardian of a child to reside in Québec for a period of more than 6 months following the date of registration of the child for health insurance. It must be signed before a commissioner for oaths.
- Declaration of the Parent Giving the Custody of their Child to a Third Person and Reason of their Presence in Québec
- Declaration of Domicile: This form is used to confirm your residential address and must only be used at our request. You must include proof of residence with your name and address as shown on the document sent to you.