Formulaire
Application for invalidity pension (Form 11174*05)
Cerfa 11174*05 (S4150)
Allows any person eligible for the invalidity pension to apply to his health insurance fund. Provides access to Package Leaflet 50531#05.
To whom shall I send this form ?
Contact the entity in charge of 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.
Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)
Verified 10 February 2022 - Directorate for Legal and Administrative Information (Prime Minister)