Changes to Personal Information

Type of Change

Address changes

Information Required along with Identifying Information*

• If your mailing address is a: P.O. Box, Rural Route, or General Delivery; you must also provide your residential (physical) address.
• Indicate all members affected by address change in Section A of this form.
• Provide apartment # if applicable.
• From time to time Canada Post informs Medicare of deleted postal codes, however please ensure when such a change occurs, that you notify Medicare.

Incorrect spelling of name(s)/change of name

• If returning to previous birth last name, a copy of birth certificate is required if you were not born in NB. If born in NB, indicate this on the form and provide name as it appears on the birth certificate.
• Last name change due to marriage requires a copy of the marriage certificate.
• First or last name change for reasons other than above, require a copy of the legal name change document.
• If not born in Canada, provide a copy of your Canadian Immigration document. Names will only be corrected as they appear on Canadian Immigration documents. 

Incorrect date of birth

• A copy of birth certificate or valid Canadian passport required if born in another Province or Territory. If born in New Brunswick, indicate this on the form and provide name as it appears on the birth certificate. 
• If not born in Canada, provide a copy of your Canadian Immigration document. Date of birth will only be corrected as they appear on you Immigration, Refugees and Citizenship Canada document.

Marriage (or common law and want to be registered as household on Medicare Files) 

• Provide spouse’s name, date of birth and Medicare number.
• Include dependents accompanying spouse. A copy of legal custody documents may be required. 
• If name change is required provide: former name, chosen (married) name, Medicare number and copy of marriage certificate.

Divorce or separations

• Indicate with whom dependents are residing, if applicable. A copy of legal custody documents may be required. 
• Provide identifying information on ex-spouse: name, date of birth, Medicare number and address (if known). 
• If changing name, see above “Name Change”.
• If changing address see address change above.

Custodial changes

If under the age of 16: 

• Copy of custody papers and/or guardianship order along with a letter containing identifying information for all affected members. 

Over the age of 16 and under 19: 

• Letter signed by both the parent/guardian and the child indicating the arrangements made along with identifying information. 

Additional Eligible Household Member (Newborn, Adoption or Minor Dependant)

• Power of Attorney documents are required if you are completing this form on behalf of a current eligible NB resident who is 19 years of age or older.
• If you wish to add a dependant to your household who is under the age of 19, legal custody documents are required.
• To add an adopted a child (born in NB) to your household, please provide birth certificate and  legal adoption documents. If the child was not born in New Brunswick, an Application for Registration form must be completed and required documents provided (see applying for Medicare Coverage).

Gender change

• If your gender has changed, complete change form and provide a copy of new birth certificate indicating gender change.