Cerfa 15763 (S 1106a) — Application to Open Your Rights to French Health Insurance

What is Cerfa 15763 - joining French health insurance?

In France, anyone who works, or who lives in France stably and lawfully, is entitled to have their healthcare costs covered by the Assurance Maladie. This is the Protection universelle maladie (PUMa), which replaced the basic CMU on 1 January 2016. Cerfa 15763*02, also numbered S 1106a, is the form you use on arrival when you are not yet attached to a French social security scheme. You send it with supporting documents to the health insurance fund (CPAM) where you live. A spouse, cohabiting partner or PACS partner who joins someone working or living in France fills it in too.

The form has three parts. Part A identifies you: your name, social security number if you have one, family allowance (CAF) number, birth date and place, nationality, address, phone and e-mail. Part B is your work situation: working, not working, or another situation, with your arrival date. Part C is a sworn statement that the details are accurate. Page 2 lists the supporting documents for each situation.

FileIt asks the questions in plain English and prints your answers into the official PDF. It fills in your name, date of birth and e-mail from your People records and checks the key of your social security number. It prints names with Polish, Romanian and other accents correctly. The filled PDF is saved in your vault. You sign it by hand and post it yourself. FileIt never sends forms.

Who needs to fill out Cerfa 15763 - joining French health insurance?

• People who have just moved to France to work and are not yet affiliated to a French scheme.
• People who live in France stably and lawfully without working. Most need three months' residence first.
• Spouses, cohabiting partners and PACS partners joining or accompanying someone who works or lives in France.
• Students enrolled under cultural, technical or scientific cooperation agreements.
• Recognised refugees and people with subsidiary protection.
• People coming back to France after international volunteering abroad.
• People receiving family allowances, housing aid, AAH, RSA, ASPA or ASI.

When to use Cerfa 15763 - joining French health insurance

• As soon as you arrive in France if you work, or once you are in a situation covered without delay (listed on page 2).
• Otherwise, once you can prove more than three months of residence in France. Page 2 says that without work you must show three months' residence before healthcare costs are covered.
• Not if you remain covered by another country's social security, for example as a posted worker or a pensioner of another country. The form says to give your CPAM an S1 form, or an equivalent document for countries outside Europe.

What you need before you start

• Your name at birth, any used name, and all your first names in the order on your birth certificate.
• Your French social security number (13 characters plus a 2-digit key), if you already have one.
• Your CAF family allowance number, if you have one.
• Your date and place of birth, nationality, address in France, phone and e-mail.
• Proof of identity: a copy of your ID card or passport. Non-EU/EEA/Swiss nationals need a copy of a valid residence permit or document, such as a titre de séjour, a VLS-TS or an asylum application certificate.
• If you have no French social security number and were born abroad, a full copy or extract of your birth certificate with parentage. The CPAM will tell you if it needs translating.
• Proof of work, such as an employment contract or payslip, or proof of more than three months' residence, such as a lease, rent receipts or energy bills.
• Your bank details (RIB / IBAN) for reimbursements.
• Form S3705 if you have children under 18 to attach to your cover.

What’s on Cerfa 15763 - joining French health insurance

The 2026 edition has 2 pages. FileIt asks for it in 3 parts, and it is signed by Applicant:

1. A - Identification du demandeur (about you)Applicant
2. B - Situation du demandeur au regard de l'emploi (work)Applicant
3. C - Attestation sur l'honneur (declaration)Applicant

How to fill out Cerfa 15763 - joining French health insurance, step by step

1 A. Identification du demandeur

Write your family name at birth, then any used name, then your first names in civil-status order. FileIt prints the family names in capitals, as French forms expect. Add your social security number and key if you have one; leave them empty otherwise and the CPAM will get you a number. Then give your CAF number and which CAF, your date and town and country of birth, and your nationality: French, EU/EEA/Swiss, or other. Finish with your address and postcode, a French 10-digit phone number and your e-mail.

If you have no personal address, give the name and address of the approved body where you have your domiciliation, such as a CCAS or an approved association.

2 B. Situation au regard de l'emploi

Tick Activité professionnelle if you work and say which activity. Tick Sans activité if you don't work, or Autre with a short description of your situation. If you don't work or tick another situation, give your date of arrival in France.

3 C. Attestation sur l'honneur

You undertake to tell the health insurance fund straight away about any change to part A and about any move of your main residence abroad. You also certify that everything is accurate. Write the place and date, and sign.

4 Pièces justificatives (page 2)

Page 2 lists what to enclose for your situation. That means proof of identity, and a residence permit if you are not from the EU/EEA/Switzerland. It also asks for a birth certificate if you have no social security number and were born abroad, and proof of work or of your situation. Without work, you need proof of more than three months' residence unless you are in a listed exempt situation. Add your bank details, and form S3705 for children under 18.

Common mistakes to avoid

• Using this form while you are still covered by another country's scheme. Posted workers and foreign pensioners give the CPAM an S1 form instead.
• Mistyping the social security number or its key. FileIt checks that the key matches.
• Writing first names in a different order from the birth certificate.
• Forgetting the arrival date when you don't work.
• Sending the form without the page-2 documents, especially proof of residence or a residence permit.
• Leaving children out. Minors are added with the separate form S3705.

After you fill it out

Print, sign part C by hand, and gather the supporting documents listed on page 2.

Post the form and documents to the health insurance fund (CPAM) where you live. The form says to return it to the fund for your place of residence. FileIt does not send it for you.

Keep the filled PDF in your FileIt vault with your passport and residence permit. When you receive your social security number and attestation de droits, store them in the vault too.

Cerfa 15763 - joining French health insurance: frequently asked questions

Official sources

• Blank form (PDF), published by Assurance Maladie (Caisse nationale de l'assurance maladie, CNAM) - via your local CPAM: https://www.formulaires.service-public.fr/gf/cerfa_15763.do
• Official instructions and guidance: https://www.service-public.gouv.fr/particuliers/vosdroits/F34306
• Edition shown on this page: Cerfa N° 15763*02 (S 1106a) (checked 2026-09-28).

FileIt is not affiliated with or endorsed by Assurance Maladie (Caisse nationale de l'assurance maladie, CNAM) - via your local CPAM or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-09-28.

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