Disability Insurance - Declaration of status and resources (Form 11237*03)

Ministry of Health - Cerfa n° 11237*03
Autre numéro : S4152d

This form is a specimen posted for information.

It allows you to report your situation and your resources in order to calculate the amount of pension to be paid.

Go to the online administrative form

Verified 10 February 2022 - 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.