Forms Portal

Manitoba Public Insurance / All Categories

This letter is issued to the claimant to provide them further information or steps they must take to request a review of the decision regarding their entitlement to physiotherapy treatment.

Departments/Crowns:Manitoba Public Insurance, Workers Compensation Board

(Decision Letter) Physiotherapy - No Treatment Beyond Category 1

This letter is issued to the claimant to provide them further information or steps they must take to request a review of the decision regarding their entitlement to physiotherapy treatment.

Department/Crown:Manitoba Public Insurance

15-Day DL Cancellation Letter - non-resident

15 Day Cancellation Letter for Failure to Prove Residency in Manitoba.

Department/Crown:Manitoba Public Insurance

157(1) Medical Form

This form is used by physicians to report an individual's disease or disability.

Department/Crown:Manitoba Public Insurance

180 Day Determination Employment Reference Form

This form is used MPI to collect a claimant's employment history.

Department/Crown:Manitoba Public Insurance

180 Day Determination Information Request

This letter is issued to the claimant to request that they provide a copy of their income tax returns and employment information to determine their entitlement to income replacement indemnity.

Department/Crown:Manitoba Public Insurance

2011 Accreditation Agreement

This form is used by MPI to affirm the terms and items of an accreditation agreement.

Department/Crown:Manitoba Public Insurance

7-Day Temporary Snopass Application

This form is used by Manitoba or non-Manitoba resident customers to apply for a 7-day temporary Snopass.

Department/Crown:Manitoba Public Insurance

7-Day Temporary Snopass Cancellation Application

This form is used by customers to cancel a 7-day temporary snopass.

Department/Crown:Manitoba Public Insurance

Abstinence Form

This form is used by a customer to report their drug/alcohol abstinence.

Department/Crown:Manitoba Public Insurance

Accident Benefits Application Form

MPI provides this form to a customer who is applying for accident benefits under the Personal Injury Protection Program (PIPP) after being involved in a collision.

Department/Crown:Manitoba Public Insurance

Accreditation for Frame Only Repair Shop

This letter is sent to frame only repair shops to advise they must submit their Accreditation Agreement and Specifications/Application by a specified date.

Department/Crown:Manitoba Public Insurance

Address History Request

This policy is used when a customer requires written confirmation regarding their address history.

Department/Crown:Manitoba Public Insurance

Address History Request Form

This form is for when a customer requires written confirmation regarding their address history.

Department/Crown:Manitoba Public Insurance

Administrative Review Letters

These letters are issued to customers to provide them with the decision regarding their administrative view.

Department/Crown:Manitoba Public Insurance

Administrative Suspension - Drive Over the Limit drugs or alcohol

This form is used by law enforcement to issue a three-month administrative suspension.

Department/Crown:Manitoba Public Insurance

Administrative Suspension Refusal

This form is used by law enforcement to issue a 3-month administrative suspension.

Department/Crown:Manitoba Public Insurance

Adult Driver Training Authorization Letter

This form is used by adult driver training participants who passed the knowledge test to have their licence issued.

Department/Crown:Manitoba Public Insurance

Adult Driver Training Contract

This form is used by instructors to affirm agreement with the terms and conditions to work as an adult driver training instructor.

Department/Crown:Manitoba Public Insurance

Adult Driver Training Knowledge Test Service Approval Letter

This form is used by adult driver training participants to obtain a no-charge knowledge test and vision screening service.

Department/Crown:Manitoba Public Insurance

Adult Driver Training Participant Payment List

This form is used by instructors to record adult driver training participants who have paid for the service.

Department/Crown:Manitoba Public Insurance

Adult Driver Training Program Paper Knowledge Test

This form is used by adult driver training instructors to submit paper knowledge tests.

Department/Crown:Manitoba Public Insurance

Adult Driver Training Progress Sheet

This form is used by instructors to record in-car driving lessons.

Department/Crown:Manitoba Public Insurance

Adult Training Course Registration Application

This form is used by instructors to register participants into the Adult Driver Training program.

Department/Crown:Manitoba Public Insurance

Advance Decision Letter

This letter is issued to the claimant regarding an advance payment of their permanent payment entitlement. Last updated Jan 27, 2022.

Department/Crown:Manitoba Public Insurance

Aftermarket Stereo Estimate

MPI uses this form for estimating repair or replacement of Aftermarket Stereos.

Department/Crown:Manitoba Public Insurance

Air Brake Manual

This brochure is provided by Manitoba Public Insurance to describe our air brakes program, including any requirements a customer must satisfy in order to comply with or participate in said service or program.

Department/Crown:Manitoba Public Insurance

Alberta Funding Letter

Letter sent to an Alberta insurer confirming the retention of our services to assist in determining PIPP benefit entitlements in accordance with the Inter-Provincial Agreement between Manitoba Public Insurance (MPI) and the Province of Alberta

Department/Crown:Manitoba Public Insurance

Alcohol and Substance Use Disorder Remission Report

This form is used by customers and doctors to report if a customer has a substance use disorder based on the medical standards for driving.

Department/Crown:Manitoba Public Insurance

Alcohol and Substance Use Reporting Form

This form is used by customers and doctors to report on a driver's remission in regards to their substance use disorder.

Department/Crown:Manitoba Public Insurance

Alcohol/Drug Assessment After 2 or More Road Side Warnings

This letter is sent to customers to provide information about maintaining their licence.

Department/Crown:Manitoba Public Insurance

All Terrain Vehicles & Other Off Road Vehicles Brochure

Department/Crown:Manitoba Public Insurance

Alternate/Aftermarket Cancellation Fax Sheet

This form is completed when a repair facility deems aftermarket parts are unsuitable for the repair. This is the paper-version of the parts type change request.

Department/Crown:Manitoba Public Insurance

Amateur Radio Operator Licence Plate

This letter is sent to customers to provide information regarding their amateur radio operator licence plate.

Department/Crown:Manitoba Public Insurance

Amateur Radio Operator Licence Plate Application (New Plates)

This form is used by customers to apply for an Amateur Radio Operator Licence Plate.

Department/Crown:Manitoba Public Insurance

Amateur Radio Operator Plates

This policy describes amateur radio operator plates.

Department/Crown:Manitoba Public Insurance

Ambulance Report Request

This form to completed by City of Winnipeg Fire Paramedic Services to provide paramedic information to MPI.

Department/Crown:Manitoba Public Insurance

Amended Notice of Suspension/Disqualification

This letter is sent to customers to correct driver's licence suspension length.

Department/Crown:Manitoba Public Insurance

Amended Suspension Notice

This form is used to process an administrative suspension when the officer completed the form incorrectly, or used the wrong form.

Department/Crown:Manitoba Public Insurance

Annual Snopass Application

This form is used by non-Manitoba resident customers to apply for an annual Snopass to use the Snoman trails between December 1 and April 30.

Department/Crown:Manitoba Public Insurance

Appeal Options Brochure

This brochure is provided to customers to describe MPI's appeal options.

Department/Crown:Manitoba Public Insurance

Application for Assigned Vehicle Indentification Number

This form is for customers who require a Manitoba-assigned vehicle identification number (VIN) when a VIN has been removed, altered, lost or destroyed.

Department/Crown:Manitoba Public Insurance

Application for Auto Insurance

This form is used by customers to apply for auto insurance.

Department/Crown:Manitoba Public Insurance

Application for Autopac Agency Appointment

This form is used by brokers to provide information associated with the ownership and operation of an Autopac location appointment.

Department/Crown:Manitoba Public Insurance

Application for Caregiver Weekly Indemnity Payments from a Fatal Accident

This form is used by claimants to apply for Caregiver Weekly Indemnity (CGWI) benefits resulting from a fatal accident.

Department/Crown:Manitoba Public Insurance

Application for Compensation with Respect to a Fatal Accident

This form is used by claimants to apply for fatality benefits under the Personal Injury Protection Program (PIPP) after a collision.

Department/Crown:Manitoba Public Insurance

Application for Credit Account

This form is used by customers to apply for a credit account.

Department/Crown:Manitoba Public Insurance

Application for Dealer's Permit

This form is used by dealers to apply for a dealer's permit.

Department/Crown:Manitoba Public Insurance

Application for Non-Resident Student Identification Sticker

This form is used by customers to apply for a student permit to operate their vehicle in Manitoba, provided it is registered in their home jurisdiction (Canada or the USA).

Department/Crown:Manitoba Public Insurance

Application for Permit for Lighting Equipment

This form is to be completed when someone is applying to have specific lights attached to their vehicle. The individual applying must provide detailed information as to why their vehicle requires these lights.

Department/Crown:Manitoba Public Insurance

Application for Photo Exemption

Drivers, who wish to be photo exempt for their basic driver's licence (DL) or basic identification card (IC), for either religious or compassionate reasons, must complete an Application for Photo Exemption form.

Department/Crown:Manitoba Public Insurance

Application for Rebuilt Vehicle Certification

This form is used by body integrity inspectors to apply for certification of a rebuilt vehicle.

Department/Crown:Manitoba Public Insurance

Application for Registered Account and Direct Deposit Form

This form is issued to clinics with information and steps to obtain a registered account number for payment of their services.

Department/Crown:Manitoba Public Insurance

Application for Retirement Income Benefits

This form is used by claimants to apply for Retirement Income Benefits.

Department/Crown:Manitoba Public Insurance

Application for Review of Injury Claim Decision

This form is used by claimants to apply for a review of a claim decision under the Personal Injury Protection Plan.

Department/Crown:Manitoba Public Insurance

Application for Salesperson's Permit

This form is used by salespeople to apply for a salesperson's permit.

Department/Crown:Manitoba Public Insurance

Appointment of Representative and Authorization for the Release of Information

This form is used by claimants to authorize a specified person to act on their behalf in all matters relating to their injury claim.

Department/Crown:Manitoba Public Insurance

Appraisal Letter to Customer

This letter is issued to customers informing them that MPI has received notice of their hired appraiser and requesting them to have their appraiser contact MPI's appraiser.

Department/Crown:Manitoba Public Insurance

Appraisal Letter to MPI Appraiser

This Letter is issued to the appraiser to confirm that they agreed to act as MPI appraiser on an appraisal case.

Department/Crown:Manitoba Public Insurance

Appraisal Letter to Owner Commercial Claims

Department/Crown:Manitoba Public Insurance

Approval for Assigned Vehicle Identification Number

This policy is used for customers who require a Manitoba-assigned vehicle identification number (VIN) when a VIN has been removed, altered, lost or destroyed.

Department/Crown:Manitoba Public Insurance

Approval for Category 3 Treatment

This letter is issued to the claimant's physiotherapist or athletic therapist, with a copy to the claimant, providing approval of funding for treatment.

Department/Crown:Manitoba Public Insurance

Arbitration Decision

This form is used by an arbitrator when they determine the actual cash value of a vehicle or when a value cannot be agreed upon and an umpire must be appointed.

Department/Crown:Manitoba Public Insurance

Areas of Possible Scarring

This form is used by the claimant to illustrate where any abrasions, burns, cuts or lacerations have been sustained that may result in permanent scarring.

Department/Crown:Manitoba Public Insurance

Assign a Claim to the Commercial Claims Department

This policy describes information to customers about registering a claim for a heavy/specialized vehicle which is assigned to the Commercial Claims department.

Department/Crown:Manitoba Public Insurance

AT/PT - Two Way Fax Note

This form is used by MPI to request medical information. Athletic therapists and physiotherapists complete and return the form.

Department/Crown:Manitoba Public Insurance

Attached Vehicles

MPI follows this procedure to register a claim that involves a powered vehicle towing an attached vehicle.

Department/Crown:Manitoba Public Insurance

Audio Visual Agreement

This form is used by vendors to affirm agreement with the terms and conditions of ordering materials from MPI.

Department/Crown:Manitoba Public Insurance

Audio-Visual Form

This form is used by instructors to order DVDs.

Department/Crown:Manitoba Public Insurance

Audiology Form

This form is used by audiologists to provide a report on a customer's hearing.

Department/Crown:Manitoba Public Insurance

Authorization for Release of Health Care Information

This form is used by claimants to authorize a specific caregiver (or hospital or agency) to disclose personal health information to MPI about injuries sustained in an accident,

Department/Crown:Manitoba Public Insurance

Authorization for Release of Health Care Information By a Non-treating Medical Examiner

This form is used by claimants to authorize a non-treating physician to disclose their medical examination report to MPI and other health care professionals.

Department/Crown:Manitoba Public Insurance

Authorization for Release of Health Care Information By an Independent Medical Examiner

This form is used by claimants to authorize independent examiners to disclose medical examination information.

Department/Crown:Manitoba Public Insurance

Authorization for Release of Information Commercial Claims

The customer uses this form to authorize MPI to collect information concerning the motor vehicle accident.

Department/Crown:Manitoba Public Insurance

Authorization for the Release of Employment Information

This form is used by claimants to authorize the specified employer to release employment information to MPI.

Department/Crown:Manitoba Public Insurance

Authorization for the Release of Employment Information

This form is used by claimants to authorize their employer to release their employment information to MPI.

Department/Crown:Manitoba Public Insurance

Authorization for the Release of Information

This form is used by parents and legal guardians to approve a person under 18 years of age to request a knowledge test.

Department/Crown:Manitoba Public Insurance

Authorization Form (If Someone is Buying a Vehicle for Another Person)

This form is used by customers to provide authorization for someone to purchase a bid number for an auction on their behalf.

Department/Crown:Manitoba Public Insurance

Authorization Form - Policy Transaction

This form is used by customers to request a policy transaction be completed on their behalf without being present.

Department/Crown:Manitoba Public Insurance

Authorization Letter

This form is used by students who passed the knowledge test to have their licence issued.

Department/Crown:Manitoba Public Insurance

Authorization to Communicate with Manitoba Public Insurance by E-mail

This form is used by claimants to authorize MPI to communicate with them by email.

Department/Crown:Manitoba Public Insurance

Authorization to Release Medical Information to Service Canada

This form is completed by claimants to authorize MPI to provide Service Canada with information to determine their entitlement to Canada Pension Plan disability benefits.

Department/Crown:Manitoba Public Insurance

Auto Repair Letter

This letter is issued to customers reminding them they are required to repair damage to their vehicle from an accident claim involving a right of subrogation.

Department/Crown:Manitoba Public Insurance

Auto Repair Letter #2

This letter is issued to customers reminding them they are required to repair damage to their vehicle from an accident claim involving a right of subrogation.

Department/Crown:Manitoba Public Insurance

Automobile Proof of Loss

This form is completed by adjusters and consists of declarations on the terms and conditions of the insurance contract, the circumstances of a loss, and the terms of settlement.

Department/Crown:Manitoba Public Insurance

Back Cancellation Document Required Letter

Department/Crown:Manitoba Public Insurance

Banking Setup and Changes

This form is used by brokers to provide their banking information.

Department/Crown:Manitoba Public Insurance

Benefits Letter - Self Employed

Department/Crown:Manitoba Public Insurance

Bike Safety

Department/Crown:Manitoba Public Insurance

Body Integrity Inspection Certificate

Form with pre-specified items to be completed while doing a body integrity inspection.

Department/Crown:Manitoba Public Insurance

Bond of Idemnity for Lost Cheque

This form is used to customers by Manitoba Public Insurance to allow us to re submit a payment for a lost cheque or a cheque that has not been yet cashed .

Department/Crown:Manitoba Public Insurance

Broker Controlled and Non-controlled Inventory Order Form

This form is used by brokers to order controlled inventory items.

Department/Crown:Manitoba Public Insurance

Broker Criminal Record Check Review Policy

Information describing Autopac agents and criminal record checks policy.

Department/Crown:Manitoba Public Insurance

Broker Criminal Record Checks

This form is used by brokers to submit criminal record checks for employees providing Autopac services.

Department/Crown:Manitoba Public Insurance

Broker IT Setup and Changes

This form is used by brokers to request user accounts and computer configuration for MPI's software.

Department/Crown:Manitoba Public Insurance

Business Name Registration Renewals

This letter is issued to driving schools to provide them information about renewing their business name registration.

Department/Crown:Manitoba Public Insurance

Cancel Service Application

Department/Crown:Manitoba Public Insurance

Cancellation of Driving Privileges

This letter is sent to customers to request the return of their renewed driver's licence because it it suspended.

Department/Crown:Manitoba Public Insurance

Cargo Release

Department/Crown:Manitoba Public Insurance

CARS Script - Change of Address

This script is followed to explain to a customer how to make a change to their address.

Department/Crown:Manitoba Public Insurance