Formulaire

Disability Insurance - Declaration of status and resources (Form 11237*03)

Cerfa 11237*03 (S4152d)

This form is a specimen posted for information.

It allows you to report your situation and your resources in order to calculate the amount of pension to be paid.

    Fill out the form

    To whom shall I send this form ?

    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 10 February 2022 - Directorate for Legal and Administrative Information (Prime Minister)