OtterFillHow to fill in the S1106 health insurance form (Cerfa 15763)
Cerfa 15763*02, known as the S1106, is the form you send to French public health insurance (Assurance Maladie) to open your right to have your healthcare costs covered when you are not yet attached to a French social security scheme. You fill it in when you start working in France or, if you do not work, once you live in France in a stable and regular way, usually after 3 months.
Last checked against the official form:
- Form
- Cerfa 15763
- Edition
- N° 15763*02 (S 1106a)
- Issued by
- Assurance Maladie
- Form language
- Français
- Where it goes
- The health insurance fund where you live: the CPAM (general scheme) or the MSA (farm scheme), by post or at the office
- When
- When you start working in France; without work, after 3 months of stable residence, unless you are in a situation the form exempts
- What to attach
- Your bank details (RIB with IBAN), a copy of your passport or ID card, a residence permit if you are not an EU/EEA or Swiss national, and proof of your work or of 3 months of residence
- Cost
- The application is free
- Length
- 2 pages: the form on the front, the list of documents on the back
What this form is
France covers healthcare costs for everyone who works in France or, without work, lives there in a stable and regular way: this is universal health protection (Protection universelle maladie, PUMa). If you are not yet attached to a French social security scheme, this form is how you ask the health insurance to open your rights. Its official title is «Demande d'ouverture des droits à l'assurance maladie», and its numbers are Cerfa 15763*02 and S 1106a, which is why people call it the S1106.
The front has three parts: A, who you are and where you live; B, your work situation when you arrived in France; C, a statement on your honour and your signature. The back lists the documents to attach, depending on your nationality and situation. The same file also lets the fund give you a French social security number if you do not have one yet.
The form is a fillable PDF, in French only. You fill it in on screen or by hand, then print it, sign it and send it with copies of your documents. Some boxes are short (on screen the email box takes about 10 characters), so you may have to finish them by hand.
Who has to fill it in
You fill in this form if you are not yet attached to a French social security scheme and:
- You work in France, whatever your nationality.
- You do not work and live in France in a stable and regular way, usually for more than 3 months.
- You are a family member (spouse, cohabiting partner, PACS partner) who joins or accompanies, to settle in France, an insured person who works or lives in France: the form says you fill it in too.
- You come back to live in France after living abroad.
Do not use this form if:
- Another country’s social security covers you, for example as a worker posted to France from abroad or as a pensioner: you give your fund an S1 form («Inscription dans l'Etat de résidence») or, for countries outside Europe, an equivalent document.
- You want to add your minor children: that is form S3705, which you send with this one.
- You already have rights with a French social security scheme.
Field-by-field instructions
A. About you
| On the form | What it means | How to fill it in |
|---|---|---|
| AVos nom et prénoms | Your full name as in your civil-status documents. | Write your birth family name first, then your usage name if you have one (for example a married name), then all your first names in the order of your birth certificate. If you are an artist-author who uses a pseudonym, add it after your family name. |
| AVotre n° de sécurité sociale (si vous en avez un) | Your French social security number, if you already have one. | Write the 13 digits in the long box and the 2-digit key in the short one. If you have never had a French number, leave it blank: the fund gives you one. |
| AVotre n° d’allocataire (allocations familiales, si vous en avez un) / CAF de | Your claimant number with a family allowance fund (CAF), if you have one. | Fill it in only if a CAF has already given you a number: write the number, and the name of that CAF after «CAF de». Otherwise leave both blank. |
| AVotre date de naissance | Your date of birth. | Write the day, the month and the year in the boxes, 2 digits for the day and the month and 4 for the year: 3 July 1990 is 03 07 1990. |
| ACommune et pays de naissance | The town and the country where you were born. | Write both, for example «Lagos, Nigeria», spelled as in your passport or birth certificate. |
| AVotre nationalité : française / UE/EEE/Suisse / autre | Which group your nationality belongs to. | Tick française if you are French, UE/EEE/Suisse if you are a national of a country in the list on the back of the form or of Switzerland, and autre for every other nationality. Your choice decides which identity documents you attach. |
| AVotre adresse / Code Postal / Commune | Where you live in France. | Write the street and number, then the 5-digit postcode (Code Postal) and the town (Commune). Use the address where you actually live, the same as on your lease or bills. |
| AVotre n° de téléphone | A phone number where the fund can reach you. | Write a French number if you have one: the box has room for the 10 digits of a French number. |
| AVotre courriel | Your email address. | On screen the box takes only about 10 characters. The national health insurance fund (CNAM) advises adding your email address by hand on the printed form before you send it. |
| ASi vous n’avez pas d’adresse personnelle, nom et adresse de l’organisme auprès duquel vous avez élu domicile | An organisation that receives your post if you have no personal address. | Fill it in only if you have no address of your own and have chosen a postal address (élu domicile) with an organisation, for example a municipal social action centre (CCAS) or an approved association. Write its name, address, postcode and town, and attach the certificate of domiciliation it gave you. |
B. Your work situation
| On the form | What it means | How to fill it in |
|---|---|---|
| BActivité professionnelle – précisez laquelle | You have work in France. | Tick it if you work in France and say which activity in a few words, for example salarié (employee). |
| BSans activité | You have no work. | Tick it if you have no job or other work, and write the date you arrived in France in the box beside it. |
| BAutre – précisez | A situation that is neither work nor no activity. | Tick it if neither of the other boxes fits you and describe your situation in a few words. |
| Bdate d'arrivée en France | The day you arrived in France to live there. | Fill it in if you ticked Sans activité or Autre: day, month and year, 8 digits. Without work you usually have to have lived in France for more than 3 months, so give the real date and keep proof of it. |
C. Statement and signature
| On the form | What it means | How to fill it in |
|---|---|---|
| CAttestation sur l'honneur à compléter par le demandeur | Your promise to report changes, and your statement that everything is true. | There is nothing to write here. By signing you promise to tell the fund at once about any change to part A and about any move of your main home abroad, and you declare on your honour that the information is accurate. The form warns that false statements can lead to a fine, a penalty or prosecution. |
| CFait à / Le | Where and when you sign. | Write the town after «Fait à» and the date after «Le»: day, month and year, 8 digits. |
| CSignature du demandeur | Your signature. | Print the form and sign it by hand: the fund needs a signed form. |
Documents to attach (back of the form)
| On the form | What it means | How to fill it in |
|---|---|---|
| VersoPour justifier de votre identité (et de la régularité de votre séjour) | Proof of who you are and, if you are not an EU/EEA or Swiss national, that you stay in France legally. | French, EU/EEA or Swiss nationals attach a copy of their ID card or passport. Others attach a copy of a valid residence permit or document, for example a temporary or multi-year carte de séjour, a carte de résident, a long-stay visa valid as a residence permit with the passport’s identity pages, an asylum application certificate or a provisional residence authorisation. |
| VersoPour l'obtention de votre numéro de sécurité sociale : copie intégrale de votre acte de naissance ou extrait avec filiation | Your birth certificate, used to create your social security number. | If you do not know your number and were born abroad or in Wallis and Futuna, attach a full copy of your birth certificate, an extract that names your parents (filiation) or an equivalent document from a consulate, if you have one. It must be authenticated, for example with a readable stamp. Your fund tells you whether it must be translated. |
| VersoSi vous exercez une activité professionnelle | Proof that you work. | If you work, attach a copy of any document that shows it, for example your employment contract or a payslip. |
| VersoSi vous êtes sans activité professionnelle : pour justifier de la stabilité de votre résidence en France | Proof that you live in France in a stable way. | If you do not work, attach proof that you have lived in France for more than 3 months, for example a lease, successive rent receipts or energy, water or landline bills, hotel bills for the last 3 months, school certificates, or an asylum application certificate dated more than 3 months ago. If someone hosts you, they write a sworn statement with the date you moved in and add rent receipts or bills in their name for the last 3 months. If the back of the form lists your situation as covered without delay, attach proof of that situation instead. |
| VersoSi vous avez des enfants mineurs à votre charge : le formulaire S3705 | Your minor children who depend on you. | Fill in form S3705 («Demande de rattachement des enfants mineurs à l'un ou aux deux parents assurés») and send it with this one; download it from ameli.fr or ask your fund. Asylum seekers attach the asylum application certificate that names their minor children. |
| VersoPour le versement de vos prestations : votre relevé d'identité bancaire (n° IBAN) | The bank account the fund pays your reimbursements into. | Attach your bank details (relevé d'identité bancaire, RIB) showing your IBAN. |
Key terms
| Term on the form | What it means |
|---|---|
| Assurance maladie | Public health insurance: the part of French social security that pays back healthcare costs. Its website is ameli.fr. |
| Caisse primaire d'assurance maladie (CPAM) | The local health insurance fund of the general scheme. You send the form to the CPAM where you live. |
| Protection universelle maladie (PUMa) | Universal health protection: cover for healthcare costs for everyone who works in France or lives there in a stable and regular way. |
| Résider en France de manière stable et régulière | Living in France on a lasting basis (without work, usually for more than 3 months, and at least 6 months a year to keep your rights) and legally (with a residence permit if your nationality needs one). |
| Numéro de sécurité sociale | Your personal French social security number: 13 digits and a 2-digit key. It is also called the NIR. |
| Nom d'usage | A name you use in daily life besides your birth name, for example your spouse’s name. |
| N° d’allocataire (CAF) | The number a family allowance fund (Caisse d’allocations familiales, CAF) gives the people it pays benefits to. |
| UE/EEE/Suisse | The European Union, the European Economic Area and Switzerland. Their nationals need no residence permit; an ID card or passport is enough. |
| Élire domicile (attestation de domiciliation) | Choosing an approved organisation to receive your post when you have no personal address; it gives you a certificate of domiciliation. |
| Titre ou document de séjour | The document that lets a national of a country outside the EU/EEA and Switzerland stay in France, such as a carte de séjour or a long-stay visa valid as a residence permit. |
| Acte de naissance avec filiation | A birth certificate that shows your parents’ names. |
| Relevé d'identité bancaire (RIB) | A bank document with the account holder’s name and the IBAN. |
| Formulaire S1 « Inscription dans l'Etat de résidence » | A European form that registers you in your country of residence when another country pays your health cover, for example the country that pays your pension. |
Common mistakes
- 1
Applying too early without work
Without work you usually need more than 3 months of stable residence in France. Wait until you can prove it, unless the back of the form lists your situation as covered without delay.
- 2
Using this form when another country covers you
Posted workers and pensioners covered by another country’s social security do not fill in this form. They give the fund an S1 form or an equivalent document.
- 3
Names in the wrong order
Write your birth family name first, then any usage name, then all your first names in the order of your civil-status documents, spelled as in your passport.
- 4
Proof of residence that does not cover 3 months
One bill is not enough. Send successive documents covering the last 3 months, such as rent receipts or energy bills, or a host’s statement with bills in their name.
- 5
An email address that is cut off
On screen the email box takes only about 10 characters. Write the full address by hand on the printed form.
- 6
Forgetting the bank details or the residence permit
The fund pays into your account, so attach a RIB with your IBAN. If you are not an EU/EEA or Swiss national, also attach a copy of a valid residence permit or document.
- 7
Adding your children on this form
Minor children go on form S3705, which you send with yours.
- 8
Not reporting a change
By signing you promise to tell the fund at once about changes to part A and about a move abroad. Keep your address up to date with the fund.
Questions and answers
What is the S1106 form?
It is the common name of Cerfa 15763*02 (S 1106a), «Demande d'ouverture des droits à l'assurance maladie»: the request to open your rights to French public health insurance when you are not yet attached to a French social security scheme.
Where do I send the S1106?
To the health insurance fund where you live: the CPAM for the general scheme, or the MSA for the farm scheme. ameli.fr and msa.fr list the addresses. You can post it or drop it off at the CPAM; an adviser checks your file with you only if you book an appointment by phone.
Do I have to wait 3 months before applying?
If you work, no: you apply when you start working. If you do not work, you usually need to prove more than 3 months of stable residence. The back of the form lists exceptions, for example recognised refugees and beneficiaries of subsidiary protection, people back from an international volunteering placement, people who receive family allowances, housing aid, AAH, RSA, ASPA or ASI, and family members who join an insured person to settle in France.
Do I need a birth certificate?
Only to get a social security number, if you do not know yours and were born abroad or in Wallis and Futuna. It must be a full copy or an extract that names your parents, authenticated for example with a readable stamp. Your fund tells you whether it needs a translation.
Does French health insurance cost anything?
The application is free. Some people covered on residence alone may later be asked by Urssaf for a contribution that depends on their income, and the 2026 social security financing law plans a contribution for people covered without work, to be set by decree. Check the official page for the current rules.
What happens after I send the form?
The fund studies your file and may ask for more documents. You then receive your social security number, sometimes a provisional one first, and can create your ameli account, where you order your carte Vitale. The form gives no processing time.
I am an EU citizen and do not work. Is this the right form?
The form has a box for EU/EEA and Swiss nationals. Assurance Maladie’s advisers also point inactive Europeans to an online application at inactif-europeen.ameli.fr, handled by a dedicated centre (CREIC). If another European country pays your pension or your health cover, you need an S1 form instead.
Can I fill in the S1106 online?
You can fill in the PDF on screen, but you then print it, sign it by hand and send it, with copies of your documents, to your fund.
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