CMPA Rebate Application Form

2023 CMPA Rebate Application

Please complete this form and ensure you click submit to complete your application.

First Name *

Last Name *

Email *

Phone Number *

Doctors Manitoba ID

You can find your Doctors Manitoba ID in the email or letter that was sent to you.

Please answer all questions below to complete your rebate application.

If you earned income directly or indirectly from Manitoba Health during the 2023 calendar year, complete this form to claim a partial rebate of the CMPA fees that you have paid during that period. Your rebate will be prorated based on the number of months you practiced in Manitoba during that period.

Number of Months you worked in Manitoba in 2023 (January to December) *

Did you or will you receive reimbursement for your 2023 liability insurance fees from any other province? *

Yes

How many months? *

Which Province? *

Did you have your 2023 liability insurance fees paid for by any other source? *

Yes

If yes, how much? *

What Source? *

Consent for collection, use and disclosure of your personal information *

By checking this box, I consent and agree to my personal information being used to assess my eligibility for the liability insurance rebate and understand it could be shared with the Province of Manitoba (e.g. Manitoba Health), University of Manitoba, any RHA, Shared Health, Workers Compensation Board, Manitoba Public Insurance or any other employer or contractor *

View full information collection, use and disclosure statement here

If you are currently enrolled in direct deposit, your rebate will be deposited to the account we have on file. If not, you will receive your rebate payment by cheque.

Please click submit below to complete your application. You should see a message to confirm your application was successfully submitted.

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CMPA Rebate Application Form

2023 CMPA Rebate Application