Accident at work Statement of agricultural workers (Form 12502*03)
Central Fund of Agricultural Social Mutual Society (MSA) - Cerfa n° 12502*03
Autre numéro : 100 ATA 12
Vous pouvez aussi utiliser :
Accident at work Declaration of Occupational Disease and Prevention Online (DAT-MSA)
To be completed in 4 copies. The employer must send 3 copies, by registered letter with acknowledgement of receipt, to the MSA fund on which the employee who is the victim of the accident depends, within 48 hours after knowledge of the accident. It must keep the 4e copy for 5 years.
Go to the online administrative form
Verified 28 August 2017 - Directorate for Legal and Administrative Information (Prime Minister)
To whom shall I send this form ?
J'ai réalisé une démarche administrative
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