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How to use or fill out Formulaire 4249 - Sworn Statement - Proof of Residence - RAMQ

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Click ‘Get Form’ to open it in the editor.
In Section A, enter your first and last names as the owner, representative, or tenant. Then, provide the name and address of the person applying for a Health Insurance Card, including number, street, apartment, municipality, and postal code.
Move to Section B. Here, input your first and last names again along with your address and telephone number.
After completing the form, visit a commissioner for oaths to sign it. Ensure you bring a piece of ID for verification.
Once signed by the commissioner, ensure that all details are accurate before submitting the form. Remember that this declaration is valid for 45 days from the signing date.

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What is a sworn statement for RAMQ?

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.

What is a sworn statement of evidence?

Affidavit. A written statement of evidence which is sworn before a person authorised to administer affidavits, such as a solicitor. Affidavits take a similar form to witness statements, but they include a jurat instead of a statement of truth.

What is proof of residence in Qubec?

Recent bill from an energy, telephone service or cable provider (no more than three months old) Record of employment or pay slip (no more than three months old) School transcript (no more than one year old) Bank statement (no more than three months old)

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