Application for family caregiver old-age insurance (Form 14104*01)

Ministry of Health - Cerfa n° 14104*01

Allows you to request the affiliation of a family caregiver to the old age insurance.

Go to the online administrative form

Verified 15 December 2020 - Directorate for Legal and Administrative Information (Prime Minister)

To whom shall I send this form ?

For details, please use the practical information sheets :

J'ai réalisé une démarche administrative

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

Je donne mon avis