Formulaire

Accident at work Declaration of transit (Form 14463*03 (ex-60-3682))

Cerfa 14463*03 (ex-60-3682) (DAT-PRE (S6200))

To be completed in 4 copies. The employer must send 3 copies, by registered letter with acknowledgement of receipt, to the primary 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.

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    To whom shall I send this form ?

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    For details, please use the practical information sheets :

    J'ai réalisé une démarche administrative

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    Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)

    Verified 06 July 2022 - Directorate for Legal and Administrative Information (Prime Minister)