Private signature power of attorney valid for 3 months for a single payment (Form 11353*03)

National Military Social Security Fund (CNMSS) - Cerfa n° 11353*03
Autre numéro : 40178 - DIP

Allows the insured person to delegate to a third party the collection of benefits due to him by the National Military Social Security Fund in connection with the care provided.

Go to the online administrative form

Verified 04 October 2018 - Directorate for Legal and Administrative Information (Prime Minister)

To whom shall I send this form ?

J'ai réalisé une démarche administrative

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