Accident at work Farm self-employed worker's sheet (Form 12577*02)

Central Fund of Agricultural Social Mutual Society (MSA) - Cerfa n° 12577*02

To be kept by the victim.

Go to the online administrative form

Verified 11 April 2022 - 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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