Application for reimbursement of medical transport costs in personal vehicle and/or public transport (CNMSS) (Form 11162*05)

National Military Social Security Fund (CNMSS) - Cerfa n° 11162*05
Autre numéro : S3140

National health insurance fund form

To be completed in case of use of your personal vehicle and/or public transport.

Contains an explanatory note, including the documents to be attached.

Go to the online administrative form

Verified 15 April 2024 - 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

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