RAMQ form 4216, "Déclaration sous serment – Preuve de résidence" (Sworn declaration – Proof of residence), is used to attest the place of residence of a person or a family.
According to the RAMQ, it must be signed before a commissioner for oaths and remains valid for 45 days: it must therefore be signed and sent to the RAMQ within that period. The form's page was last updated on 14 December 2023.
The oath, in brief
Form RAMQ 4216 contains a declaration under oath (or a solemn affirmation): it must be signed before a person legally authorized to receive it — a Commissioner for Oaths, notary, lawyer, clerk, or justice of the peace.
In Québec, a Commissioner for Oaths can administer this oath remotely, by videoconference, when the required conditions are met (seeing and hearing each other, viewing the document, keeping it confidential).
Where to get the document
Form RAMQ 4216 is published by the Régie de l'assurance maladie du Québec (RAMQ). Its official page gives access to the document and the available versions.
Download form RAMQ 4216 (ramq.gouv.qc.ca, PDF, in French)
Have form RAMQ 4216 sworn online
Form 4216 is signed during the session: have valid photo ID and the residential address to attest on hand, then sign before the commissioner by videoconference — you receive the signed document right after, ready to send to the RAMQ before the 45-day validity period expires.
Before booking, confirm with the court registry or the receiving organization the deadlines that apply to your file.