Formulaire

Certificate of non-assumption by the insurer (Form 15173*03)

Cerfa 15173*03

Form to be completed by you and your insurer and to be attached to the application for legal aid if the latter does not cover the costs of the trial.

    Fill out the form

    To whom shall I send this form ?

    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 : Ministry of Justice

    Verified 29 November 2024 - Directorate for Legal and Administrative Information (Prime Minister)