Driver’s Licence and Policy Cancellation Request

I have obtained a driver’s licence and/or policy in another jurisdiction and am sending you this written
notice to request cancellation of my Manitoba driver’s licence and/or insurance policy.
My information is listed below.

Manitoba Public Insurance

Customer Number:

Manitoba Driver’s Licence

Number:

Name:

Street Address:

City:

Province and Postal Code:

Please only complete this next section if you’d like your Manitoba vehicle insurance policy to be cancelled
immediately:

Daytime Phone Number:

Manitoba Licence Plate or

Policy Number:

Year, Make, Model, and Serial

Number of Manitoba Vehicle:

I have included a copy of my new jurisdiction’s driver’s licence and/or insurance policy. This must be provided to
backdate the cancellation date to the effective date of your new documents.

Signature Date

Send this signed request by mail or fax to:

Manitoba Public Insurance
Basic Autopac Special Services
510-234 Donald Street
Box 6300
Winnipeg, MB R3C 4A4
Fax: 1-877-776-9060

Revised: February 2023