Formulaire

Single application for basic retirement for permanent incapacity of occupational origin

  • Public concernéPerson covered by Retirement Insurance or MSA: titleContent or the cult regime (Cavimac), a victim of an occupational disease (excluding travel accidents), aged at least 60 years and with a permanent disability rate at least equal to 10%
  • Nombre d’étapes2 steps
  • LangueLanguage French

Fill out the form

To whom shall I send this form ?

Comment faire ?

  1. Complete and sign the form
  2. Send the requested form and supporting documents to the pension fund of the plan that has recognized your permanent incapacity for

Whatever your situation, you must attach the following 3 documents:

  • Photocopy of your identity card or passport or any other proof of civil status and nationality if you are a French citizen or a national of theEuropean Economic Area or Switzerland (or photocopy of any document justifying your civil status and any document justifying the regularity of your stay in France, valid [residence permit or receipt for application or renewal of residence permit] if you are of another nationality)
  • Bank Identity Statement
  • Photocopies of your last 2 income tax notices or your last two income tax situation notices.

Depending on your situation, you may have other supporting documents to attach. The details are on page 4 of the form.

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Verified 25 August 2025 - Directorate of Legal and Administrative Information (Prime Minister)