Formulaire

Accident at work Wage certificate for agricultural worker (Form 11450*04)

Cerfa 11450*04

Certificate to be sent to the fund of the Agricultural Social Mutual Society (MSA) to which you report. The daily allowances due to the victim are calculated on the basis of the information provided.

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To whom shall I send this form ?

J'ai réalisé une démarche administrative

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Émetteur du formulaire administratif : Central Fund of Agricultural Social Mutual Society (MSA)

Verified 23 September 2016 - Directorate for Legal and Administrative Information (Prime Minister)