Acts and Regulations

84-20 - General

Schedule
Disposition versions

Full text
SCHEDULE 0.1
DECLARATION OF RESIDENCY FORM
Repealed: 2014-87
2014-87
SCHEDULE 0.1
DECLARATION OF RESIDENCY FORM
The Medical Services Payment Act defines a resident as “a person lawfully entitled to be or to remain in Canada, who makes his home and is ordinarily present in New Brunswick, but does not include a tourist, transient or visitor to the Province”.
As well, it is an offence to obtain or receive entitled services where a person is not entitled to obtain or receive them under the Act or regulations and a person who does so commits an offence punishable under Part II of the Provincial Offences Procedure Act as a category F offence.
In keeping with the above, I, ___________________ , do solemnly declare that
1.I and my dependents are residents of New Brunswick.
2.We reside at the following address:
_____________________________________________
(Street or Parish)
(City or Community)
(Postal Code)
3.We established our residency in New Brunswick on or about
_____________________________________________
(date)
4.Our mailing address is_______________________
_____________________________________________
and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath, and by virtue of the Evidence Act.
Declared before me ________
)
)
__________ at ___________
)
)
this ______ day of ________ ,
)
)
20___.
)
)
)
)
___________________
)
Declarant
)
________________________
A Commissioner of Oaths or
Notary Public
86-150; 97-23; 99-29; 2009-128
SCHEDULE 0.1
DECLARATION OF RESIDENCY FORM
The Medical Services Payment Act defines a resident as “a person lawfully entitled to be or to remain in Canada, who makes his home and is ordinarily present in New Brunswick, but does not include a tourist, transient or visitor to the Province”.
As well, it is an offence to obtain or receive entitled services where a person is not entitled to obtain or receive them under the Act or regulations and a person who does so commits an offence punishable under Part II of the Provincial Offences Procedure Act as a category F offence.
In keeping with the above, I, ___________________ , do solemnly declare that
1.I and my dependents are residents of New Brunswick.
2.We reside at the following address:
_____________________________________________
(Street or Parish)
(City or Community)
(Postal Code)
3.We established our residency in New Brunswick on or about
_____________________________________________
(date)
4.Our mailing address is_______________________
_____________________________________________
and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath, and by virtue of the Evidence Act.
Declared before me ________
)
)
__________ at ___________
)
)
this ______ day of ________ ,
)
)
19___.
)
)
)
)
___________________
)
Declarant
)
________________________
A Commissioner of Oaths or
Notary Public
86-150; 97-23; 99-29; 2009-128
SCHEDULE 0.1
DECLARATION OF RESIDENCY FORM
The Medical Services Payment Act defines a resident as “a person lawfully entitled to be or to remain in Canada, who makes his home and is ordinarily present in New Brunswick, but does not include a tourist, transient or visitor to the Province”.
As well, it is an offence to obtain or receive entitled services where a person is not entitled to obtain or receive them under the Act or regulations and a person who does so is liable on summary conviction to a fine of not more than one thousand dollars or to imprisonment for a term of not more than six months or to both fine and imprisonment.
In keeping with the above, I, ___________________ , do solemnly declare that
1.I and my dependents are residents of New Brunswick.
2.We reside at the following address:
_____________________________________________
(Street or Parish)
(City or Community)
(Postal Code)
3.We established our residency in New Brunswick on or about
_____________________________________________
(date)
4.Our mailing address is_______________________
_____________________________________________
and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath, and by virtue of the Evidence Act.
Declared before me ________
)
)
__________ at ___________
)
)
this ______ day of ________ ,
)
)
19___.
)
)
)
)
___________________
)
Declarant
)
________________________
A Commissioner of Oaths or
Notary Public
86-150; 97-23; 99-29