Formulaire

Application for payment of personal health costs in the event of sickness or maternity (Form 15680*01)

Cerfa 15680*01 (S1110)

To be used if you were attached to a social security policyholder and apply to become insured. To do this, you must be at least 16 years old.

    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 : National Health Insurance Fund (Cnam)

    Verified 14 October 2024 - Directorate for Legal and Administrative Information (Prime Minister)