Formulaire

Carpimko: Declaration of affiliation (Form)

Supporting documents that must be attached to your return:

  • A copy of your Health Care Professional Card

OR

  • The certificate of registration in the ADELI directory if you are a nurse, speech therapist or orthoptist
  • Notification of registration on the order board if you are a masseur-physiotherapist or pedicure-podiatrist
  • If you perform occasional replacements, you can fill in the "Replacement Attestation" in your Personal Space.

In the case of an exercise in business: the articles of association of your business and the minutes (or other supporting documents) on which the allocation and the date of acquisition of the shares in the company's capital are shown.

Please note

Once you are a member of CARPIMKO and to facilitate your management, you can request to pay your contributions by direct debit via a SEPA mandate directly fillable in your CARPIMKO Personal Area.

    Fill out the form

    To whom shall I send this form ?

    • Carpimko

      CARPIMKO

      Collections department

      The Quadrants

      3 Avenue du Center

      CS 50035

      78882 ST QUENTIN EN YVELINES Cedex

    For details, please use the practical information sheets :

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    Émetteur du formulaire administratif : CARPIMKO

    Verified 24 July 2024 - Directorate for Legal and Administrative Information (Prime Minister)