HLTH 5357 Fair PharmaCare Income Affidavit: Fill Online

What is HLTH 5357 Fair PharmaCare income affidavit?

Fair PharmaCare sets your deductible and family maximum from your net income two years ago, which it checks with the Canada Revenue Agency. If you didn't and couldn't file a Canadian tax return for that year, there is nothing to check. HLTH 5357 fills the gap: you swear to your income for last calendar year instead.

The form lists who it is for: people who didn't live in Canada, children under 18 without income, full-time students aged 18 to 25 at a recognized post-secondary institution supported by their parents, diplomats and their spouses, members of a religious order under a vow of poverty, and people the Minister of Health has allowed to give another proof of income. Page 2 is the affidavit: your name, PHN, address and phone, then 19 income lines in two columns, one for you and one for your spouse, and a total.

FileIt asks for each amount, adds up both totals and prints everything into the official PDF. You and your spouse then sign it in front of a notary public or a Commissioner for Taking Affidavits, who completes the 'sworn before me' part. FileIt doesn't sign it for you and doesn't send it to Health Insurance BC.

Who fills it: B.C. residents who did not and could not file Canadian taxes two years ago
Income year: Last calendar year (January to December), in Canada or abroad
Pages: 2 (page 1 explains, page 2 is the affidavit)
Signatures: You and your spouse, sworn before a notary or a Commissioner for Taking Affidavits
Edition: HLTH 5357 V2 Rev. 2024/03/13
Send to: PO Box 9655 Stn Prov Govt, Victoria BC V8W 9P2 (by mail, not fax)

Who needs to fill out HLTH 5357 Fair PharmaCare income affidavit?

Newcomers to B.C. who didn't live in Canada two years ago and are registering for Fair PharmaCare.
Canadians returning from abroad who had no Canadian tax return for that year.
Young adults who were children without income, or full-time students aged 18 to 25 supported by their parents.
Diplomats accredited to represent another country, and their spouses.
Members of a religious order who took a vow of poverty and whose pay went to the order.

When to use HLTH 5357 Fair PharmaCare income affidavit

When you register for Fair PharmaCare, or PharmaCare asks you for proof of income, and there is no CRA return for two years ago.
Only when you could not have filed. The form says that if you could have filed, you should file your taxes and tell PharmaCare instead.

What you need before you start

Your Personal Health Number and your spouse's, if you have them. Leave it blank if you're still applying for MSP.
Your home address and a daytime phone number.
Last year's income for you and your spouse, by type: pay, EI, pensions, assistance, self-employment, rental and investment income, and earnings outside Canada, in Canadian dollars.
An appointment with a notary public or a Commissioner for Taking Affidavits. The form says Service BC offices have commissioners and charge a small fee to witness the signing.

What’s on HLTH 5357 Fair PharmaCare income affidavit

The 2024 edition has 2 pages. FileIt asks for it in 3 parts:

You, the registrantRegistrant
Your income for last calendar yearRegistrant
SpouseRegistrant

How to fill out HLTH 5357 Fair PharmaCare income affidavit, step by step

1 Your details

Enter your name, your PHN (or leave it blank if you're applying for MSP), your address and a daytime phone number. Add your spouse's name and PHN if you have a spouse.

2 Income

Fill in the lines that apply for last calendar year: employment, EI, workers' compensation, disability payments, OAS, CPP/QPP, RRIF, other pensions, RRSP withdrawals, social assistance and federal supplements.

3 Income after expenses

Self-employment (say what kind), rental, interest, investment income, taxable capital gains and taxable Canadian dividends, after the expenses the CRA allows.

4 World and other income

Earnings outside Canada go on their own line. Any other income goes on the last line with its source. FileIt adds up the TOTAL for you and for your spouse.

5 Swearing the affidavit

Print the PDF unsigned. You and your spouse sign it in front of a notary public or a Commissioner for Taking Affidavits, who fills in where and when it was sworn and signs and stamps it.

Common mistakes to avoid

Signing before you meet the commissioner. The affidavit has to be signed in front of them.
Using it when you could have filed taxes two years ago. The form says to file your taxes and notify PharmaCare instead.
Leaving out income you earned outside Canada. The affidavit covers last year's income wherever you worked.
Faxing it. The form says it must be mailed, because PharmaCare needs the original.

After you fill it out

Take the printed PDF, unsigned, to a notary public or a Commissioner for Taking Affidavits, with your spouse if you have one.

Mail the signed original to PO Box 9655 Stn Prov Govt, Victoria BC V8W 9P2.

Keep a copy in your FileIt vault.

Fill out HLTH 5357 Fair PharmaCare income affidavit online with FileIt

Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 48 fields in all. Your answers save as you go.
Check the live preview. Watch your answers land on the real BC Ministry of Health / Health Insurance BC form, and let FileIt do any worksheet arithmetic.
Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start HLTH 5357 Fair PharmaCare income affidavit now — it’s free

HLTH 5357 Fair PharmaCare income affidavit: frequently asked questions

Who can use the Fair PharmaCare Proof of Income Affidavit?

The form says it is for B.C. residents who did not and could not file taxes with the CRA two years ago, for example because they didn't live in Canada, were a child without income, a supported full-time student aged 18 to 25, a diplomat, or a member of a religious order under a vow of poverty.

Which year's income do I declare?

The calendar year immediately before the current one, January to December, whether you worked in Canada or outside it.

Does my spouse have to sign?

Yes, if you have one. The form says you and your spouse must sign in front of a notary public or a Commissioner for Taking Affidavits.

Where can I get it witnessed?

The form says Commissioners for Taking Affidavits are available at Service BC offices, which charge a small fee, and you can book through gov.bc.ca/ServiceBC or by phone.

Can I fill out HLTH 5357 with FileIt?

Yes. FileIt prints your details and income into the official PDF and adds up the totals. You swear and sign it in person, then mail it. FileIt never sends it for you.

Official sources

Blank form (PDF), published by BC Ministry of Health / Health Insurance BC: https://www2.gov.bc.ca/assets/gov/health/forms/5357fil.pdf
Official instructions and guidance: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/who-we-cover/fair-pharmacare-plan
Edition shown on this page: HLTH 5357 V2 Rev. 2024/03/13 (checked 2026-10-25).

FileIt is not affiliated with or endorsed by BC Ministry of Health / Health Insurance BC or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-25.