Formulaire

Wage certificate issued by the employer in case of continuous interruption of more than 6 months (Form 11136*05)

Cerfa 11136*05 (S3202f)

Fill out the form

To whom shall I send this form ?

Contact the entity in charge of this form

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 11 April 2022 - Directorate for Legal and Administrative Information (Prime Minister)