Formulaire

Solidarity Complementary Health Application (Form 12504*13)

Cerfa 12504*13 (S3711n)

You will need to fill in your Caf beneficiary number.

This form allows you to apply for the complementary health solidarity.

This form includes an integrated leaflet.

The form lists the supporting documents to be produced and the information to be provided regarding the composition and resources of your household, the specific situations related to the RSA and the choice of the complementary organization.

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