Care received abroad - Declaration to be completed by the insured (Form 12267*06)

National Health Insurance Fund (Cnam) - Cerfa n° 12267*06
Autre numéro : S3125e

Allows you to submit your refund request (with proof) to your cash register if you received treatment during a stay abroad.

Go to the online administrative form

Verified 07 March 2024 - Directorate for Legal and Administrative Information (Prime Minister)

To whom shall I send this form ?

Contact the entity in charge of this form

J'ai réalisé une démarche administrative

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