Death Certificate

Funeral Home Statement of Death

The form may be completed by the surviving family members, executor, or funeral chapel.

Please include the Health Card Registration Number and Personal Health Identification Number (PHIN) for the individual if available.

When you are ready, complete the following form:

Notification of Death Form - Manitoba Health (PDF)

To submit your request, kindly send the completed form and required supporting document to one of the following:

Email: insuredben@gov.mb.ca
OR
Mail:
Registration and Client Services Unit
Manitoba Health
300 Carlton Street
Winnipeg, Manitoba R3B 3M9
OR
In Person Drop Off available at 300 Carlton Street
Business hours: Monday to Friday, 8:30am to 4:30pm

If there are surviving dependents on the family health card please contact Registration and Client Services at your earliest opportunity. Dependent’s (under the age of 18) coverage may be immediately affected if their parent or guardians’ coverage is canceled.