Formulaire

Medical certificate of childbirth to establish an act of lifeless child (Form 13773*02)

Cerfa 13773*02

To be completed by the doctor or midwife.

You must transmit to the registrar the detachable part of the form (lower part) to ask him to establish an act of lifeless child.

    Fill out the form

    To whom shall I send this form ?

    For details, please use the practical information sheets :

    J'ai réalisé une démarche administrative

    Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

    Je donne mon avis

    Émetteur du formulaire administratif : Ministry of Health

    Verified 29 December 2025 - Public Service / Directorate of Legal and Administrative Information (Prime Minister)