Formulaire

Claim for Remaining Maternity Leave Due Following the Death of a Newborn Mother (Form 15411)

Cerfa 15411 (S3186)

  • Public concernéFather, regardless of the regime under which he is a member, of a child whose mother died after birth or spouse, partner of Civil partnerships: titleContent or cohabiting partner of the deceased mother, irrespective of the scheme under which he is covered, if the father of the child does not apply for the remainder of the maternity leave
  • CoûtService free
  • Nombre d’étapes5 steps
  • LangueLanguage French

Fill out the form

To whom shall I send this form ?

Comment faire ?

  1. Fill the online form
  2. Download the form
  3. Print it
  4. The sign
  5. Send it to your employer administration with the documents to be attached

The documents to be attached differ depending on the situation:

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You are the father of the child

If you are the father of the child and you have not already applied for paternity and child care leave, you must provide the following 2 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 child care leave, you must provide the following 3 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 Instance or certificate on the honor of cohabitation
  • Declaration on the honor of termination of your professional activity.

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Verified 24 November 2025 - Public Service / Directorate of Legal and Administrative Information (Prime Minister)