Formulaire

Application for death benefit

Cerfa 10431*05 (S3180i)

Any person dependent on the deceased, on the day of death, whether or not related to the deceased or in the absence of a dependent, spouse or common-law partner of the deceased Civil partnerships or in the absence of a Civil partnership or partner, descendants of the deceased or in the absence of a spouse or partner of Civil partnerships and descendants, ascendants of the deceased
Service free
5 steps
Language French

Comment faire ?

Fill the online form
Download the form
Print it
Sign it
Send it to the CPAM to which the deceased belonged with the necessary supporting documents

In original or photocopy:

If the deceased was of foreign nationality: any valid document justifying the regularity of the stay in France
If you are the spouse of the deceased: up-to-date family record book or marriage certificate
If you are the Civil partnership partner: document issued by the registry of the court that registered the Civil partnership or your birth certificate mentioning it
If you are a descendant or one ascending of the deceased: his booklet or your up-to-date family booklet or any document showing your relationship with the deceased
If you are French or national of a country party to theEuropean Economic Area or switzerland: your identity card or your passport or any other proof of civil status and nationality
If you are a national of another country: any valid document proving your civil status and the regularity of your stay in France
Your bank identity statement

The form contains a explanatory note #50193#05.

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Verified 30 March 2026 - Entreprendre Public Service / Directorate of Legal and Administrative Information (Prime Minister)