24. To have a lost, damaged or stolen health insurance card replaced, an insured person or his representative shall apply in writing, using the form supplied by the Board for that purpose, shall pay any applicable fees and shall provide the following information and documents:
(1) the information prescribed in paragraphs 1 to 5 of section 14;
(2) the person’s health insurance number, where available;
(3) the reason for the application for replacement of a card;
(4) subject to sections 8 to 8.0.3 of the Regulation respecting forms and statements of fees under the Health Insurance Act (chapter A-29, r. 7), a color photograph measuring 43 mm × 54 mm (1 11/16 × 2 1/8 in), on a white background, taken in the last 6 months, showing the person facing front, from the shoulders up and bare headed; the photograph shall be dated on the back with a date stamp;
(5) except for an application for which the Board issued a health insurance card without the photograph and signature of the insured person under sections 8, 8.0.1 and 8.0.2 or, where applicable, section 8.0.3 of the Regulation respecting forms and statements of fees under the Health Insurance Act, an authentication document duly completed in the manner prescribed in Division V;
(6) in the case of a person who is unable to provide a domiciliary address because he is homeless, a declaration signed and dated by a worker with a local employment centre or with an institution to the effect that the worker knows the person and that the person lives in Québec;
(7) a declaration signed and dated by the insured person or by his representative attesting that the information provided is accurate.