Certificate of non-assumption by the insurer (Form 15173*02)

Ministry of Justice - Cerfa n° 15173*02

Form to be completed by you and your insurer and to be attached to the application for legal aid if the latter does not cover the costs of the trial.

Go to the online administrative form

Verified 20 July 2021 - 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