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Single application for a basic pension for permanent incapacity of occupational origin (Form)

National old-age insurance fundAutre numéro : S5130b

This form allows you to apply for your basic permanent disability pension if you have a permanent disability of at least 10% accident at work as a result of an occupational disease or illness for all the activities you have carried out as:

  • Employee, head of company, collaborating partner, craftsman, merchant and industrialist, etc. (Pension insurance)
  • Agricultural worker, farm manager or farm company, worker and family helper (MSA: titleContent)
  • Minister of Worship or Religion (Cavimac).

Go to the online administrative form

Verified 08 March 2022 - Directorate for Legal and Administrative Information (Prime Minister)

To whom shall I send this form ?

Contact the entity in charge of this form

For details, please use the practical information sheets :