Formulaire

Widower's disability pension application (Form 11791*03)

Cerfa 11791*03

This form allows you to apply for a widow's disability pension if you are:

  • Widow of deceased employee,
  • Aged under 55
  • Disabled.

The form shall contain an explanatory note specifying the supporting documents to be provided in support of the application.

    Fill out the form

    To whom shall I send this form ?

    Contact the entity in charge of this form

    For details, please use the practical information sheets :

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    Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)

    Verified 11 March 2025 - Directorate for Legal and Administrative Information (Prime Minister)