Formulaire

Declare a {circumflex over (a)} or journey

Cerfa 14463*03 (ex-60-3682) (DAT-PRE (S6200))

To be completed in 4 copies. The employer must send 3 copies, by registered letter with acknowledgement of receipt, to the primary fund to which the employee who is the victim of the accident depends, within 48 hours of becoming aware of the accident. It must keep the 4^e copy for 5 years.

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To whom shall I send this form ?

Primary Health Insurance Fund (CPAM)

For details, please use the practical information sheets :

Responding to an emergency: obligations of the employer

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

Verified 17 April 2026 - Entreprendre Public Service / Directorate of Legal and Administrative Information (Prime Minister)