Formulaire

Claim for compensation for maternity leave remaining due following the death of the mother of a newborn

Cerfa 15411 (S3186)

  • Father of the child or spouse or common-law partner who lives as a couple with the mother or, in the event of early joint recognitiona mother who has not given birth in the case of a married, entered into a civil partnership or common-law relationship
  • Service free
  • 5 steps
  • Language French

Fill out the form

Comment faire ?

  1. Fill the online form
  2. Download the form
  3. Print it
  4. The sign
  5. Send it to your health insurance organization or your affiliating treaty body or, if you are a civil servant, to your employer

Documents to attach differ according to the situation :

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You are the father of the child

If you are the father of the child and have not already applied for paternity and foster care leave, you must provide the 2 following documents:

  • Copy of the updated family record book or full copy of the child's birth certificate or copy of the act of recognition of the child by yourself
  • Declaration on the honor of termination of your professional activity.

You're not the child's father

If you are not the father of the child and you have not already applied for paternity and childcare leave, you must provide the 3 following documents:

  • Full copy of the child's birth certificate
  • Copy of your family booklet if you were married or copy of the certificate of registration of your Civil partnership, delivered by the court of first instance or certificate on the honor of cohabitation
  • Declaration on the honor of termination of your professional activity.

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Verified 12 June 2026 - Public Service / (Prime Minister)