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  • Manitoba.ca
  • > Transportation and Infrastructure
  • > Licence Suspension Appeal Board
  • > Forms and Sample Letters

Forms and Sample Letters

Forms

  • Application for Appeal (PDF, 103 KB)
    • Application Checklist (PDF, 305 KB)
    • Documentation Requirements (PDF, 222 KB)
  • Application for Variation (PDF, 90 KB)
  • Application for New Evidence and Change in Circumstances (PDF, 52 KB)
  • Medical Supplemental Information Sheet (PDF, 106 KB)
  • Work Supplemental Information Sheet (PDF, 64 KB)
  • Authorization to Disclose Information (PDF, 97 KB)
  • Request for Ignition Interlock Exemption in Company Vehicle (PDF, 45 KB)
  • Board Order Replacement (PDF, 50 KB)
  • Application for Permit and Operator Appeals (PDF, 150 KB)
  • Permit/Operator Documentation Guidelines (PDF, 107 KB)
  • Residency Application Form

Sample Letters

  • Sample Employer Letters (PDF, 203 KB)
  • Sample School/Daycare/Child Access Letters (PDF, 192 KB)

 

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  • Licence Suspension Appeal Board and Medical Review Committee
  • Licence Suspension Appeal Board
    • Application process
    • Attending and preparing for a Hearing
    • Suspended or Prohibited as a result of a Criminal Code Conviction
    • Variation to a Conditional Driver’s Licence
    • Application for New Evidence and Change in Circumstances
    • Forms and Sample Letters
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  • Medical Review Committee
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Government of Manitoba