Request for supplementary health solidarity (Form 12504*10)

National Health Insurance Fund (Cnam) - Cerfa n° 12504*10
Autre numéro : S3711k

Please enter your Caf Allocator Number.

This form allows you to request the complementary health solidarity.

This form includes an integrated package leaflet.

The form lists the supporting documents to be submitted and the information to be supplied concerning the composition and resources of your household, the specific situations related to the RSA and the choice of the complementary organism.

Go to the online administrative form

Verified 04 April 2023 - Legal and Administrative Information Directorate (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.