21. A resident of Québec shall complete the notice of renewal and provide the following information and documents:(1) 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;
(2) if the applicant has, since the last renewal or since the birth or adoption, as the case may be, been outside Québec for a total of 183 days or more in a calendar year, excluding periods of 21 consecutive days or less, the dates of departure from and return to Québec, the places where the applicant stayed and the reasons for those stays;
(2.1) for the renewal of a card referred to in subparagraph 1 of the first paragraph of section 23, if, during the 12-month period preceding the expiry of the card, the applicant was outside Québec for a total of 183 days or more, excluding periods of 21 consecutive days or less, the dates of departure from and return to Québec, the places where the applicant stayed and the reasons for those stays;
(2.2) where the information provided under subparagraphs 2 and 2.1 is incomplete or the Board holds information that contradicts or conflicts with the information provided, any document substantiating the information required under subparagraphs 2 and 2.1;
(3) any change affecting the information and documents provided under sections 14 and 15;
(4) in the case of a person who has forfeited the status of resident of Québec under section 6, proof of residency in Québec as prescribed in paragraph 7 of section 15 with the necessary modifications;
(4.1) if the applicant is a person referred to in the second paragraph of section 7 of the Act, a sworn statement as prescribed in subparagraph 9.1 of the first paragraph of section 15;
(4.2) if the applicant is a permanent resident within the meaning of the Immigration and Refugee Protection Act (S.C. 2001, c. 27) who has left Canada for 183 days or more, the original of the document issued by Canadian immigration authorities attesting that the applicant has retained permanent resident status;
(5) except for an application for which the Board issued a health insurance card without the photograph and signature of the insured person under section 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) a declaration signed and dated by the applicant or by his representative attesting that the information furnished in the notice of renewal and the information provided is true and accurate.