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CPAM - Health cover


Deb
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We have been speaking to CPAM English helpline and they have asked us to complete an S3710 form which has duly arrived.  This is a long detailed form (all in French) and I am struggling to translate it, I have a translator on my computer but it is very literal.  Does anyone know if there is an English version of this form anywhere?

Any help appreciated.

Deb

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http://www.ameli.fr/fileadmin/user_upload/formulaires/S3710.pdf

To the best of my ability...

  • Under Vous-même, complete with your details: surname, name, DoB, nationality, address, postcode, town, tel, SS number if you have one, name of other French health authority you may have been registered with previously,
  • Under Votre conjoint..., complete with your wife's, husband's or partner's details as above.
  • Under Les autres personnes à charge, list dependenst (children, elderly parents...) living with you, giving their full name, relation to you, DoB and SS number if any.
  • Page 3, list your income for 2007 for yourself, your wife/husband/partner and dependents, including income from outside France (note: income includes pensions, gite rental, UK property rental...)

    1. yes/no

    2. the RFR shown on your 2007 French income tax bill if you have one. If nobody has had any income, no need to go any further, just sign at end of pg 3.

    3. any allowance received in 2007 (benefit of any kind): yes/no

    4. salary earned
    5. leave blank

    6. unemployment benefit
    7. taxable pensions
    8. alimony
    9. any other income ( gite rental, UK property rental...)
    10. deductions as shown on 2007 income tax bill, if any
    11. tax credit as shown on 2007 income tax bill, if any
Date and sign in the blue area. Include the items listed on page 2 as required. Photocopy and send original.

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