Formulaire

Future protection mandate (Form 13592*04)

Cerfa 13592*04

Allows an adult or emancipated minor (the principal) to appoint a person to become his or her agent. The latter must accept and indicate expressly on this form that it agrees to fulfill this mission entrusted by the principal.

    Fill out the form

    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.

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    Émetteur du formulaire administratif : Ministry of Justice

    Verified 24 January 2023 - Directorate for Legal and Administrative Information (Prime Minister)