[Name and address of the association]

[Municipality of the registered office of the association] , on [date]

Madam, Sir,

Our association, which was declared to the prefecture of [reporting department] the [date of declaration] , is intended to receive public subsidies.

[Depending on the situation:] Our association includes the following institution(s): [name] , [skill]

Please assign a Siren number / [depending on the situation:] the Siren and Siret numbers are useful.

Our main activity is ...............................

Copies of its statutes and of the publication witness are attached in the Official Journal.

Please accept, Madam, Sir, the assurance of my esteemed consideration.

[[First name, last name and signature]] ,

President