Formulaire

Care received abroad - Declaration to be completed by the insured (Form 12267*06)

Cerfa 12267*06 (S3125e)

Allows you to submit your refund request (with proof) to your cash register if you received treatment during a stay abroad.

    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 :

    J'ai réalisé une démarche administrative

    Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

    Je donne mon avis

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

    Verified 14 June 2024 - Directorate for Legal and Administrative Information (Prime Minister)