Current Page 1 Page 2 Preview Personal information on this form is collected under Section 31 (c) of the Freedom of Information and Protection of Privacy Act and will be used for administering the Social Assistance Act or the Supports for Persons with Disabilities Act. If you have any questions about this collection of personal information, you may contact the Manager of Administration, Social Programs, Department of Social Development & Housing, 902-368-5230. Identification First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Date of Birth Personal Health Number (PHN) Social Insurance Number (SIN) Do you have a spouse? - Select -YesNo Spouse Information First Name Last Name Date of Birth Personal Health Number (PHN) Social Insurance Number (SIN)