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Other forms

CIVIL STATUS

(marriage, cohabitation agreement, PACS (civil partnership contract), divorce, cancellation of contract, de facto or legal separation)

MEDICAL BENEFITS

(for entitlement)

(complétée par l'assuré)

(completed by the insured)

(completed by the insured and the practitioner)

(completed by the insured)

(completed by the insured)

BENEFITS PAYMENTS

(bank details)

OTHERS