Completing the Residency Statutory Declaration

Who should complete the Residency Statutory Declaration?

  • Individuals who have moved to the NWT and intend to stay here for more than a year, but can’t provide two documents that show that they live here.
  • Individuals leaving the NWT for long winter vacations.

Completing the Residency Statutory Declaration

To maintain your health coverage, submit a Temporary Absence Form if you plan to be outside of the NWT for more than 90 days.


  • None



  • There is no fee.

Contact this Service

Phone: 1-800-661-0830 (toll free)
Hours: 9:00 AM – 4:30 PM (Monday to Friday, closed statutory holidays)

Sending the Completed Form…

Health Services Administration

Department of Health and Social Services
Bag #9
Inuvik, NT X0E 0T0
Fax to: 1-867-777-3197
Email to:

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