Nouvel embauché CARSAT

Fiche de renseignements des agents

"CARSAT"

A compléter en lettres "MAJUSCULES"

Service

Site

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Code postal

Ville

Portable

Professionnel

Mail personnel

Situation familiale

Type de contrat

Date début de contrat

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Copie du contrat

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Date de fin contrat CDD

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Renseignements conjoint et enfant(s) à charge(s)


Nom	Prénom	Catégorie	Date de naissance	Justificatif obligatoire*
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			`{"name":"Date-naissance3","value":"","required":false,"disabled":false,"showTime":false,"rows":1,"cols":1,"title":false,"showDate":true,"preloadCalendar":false,"id":null,"placeholder_date":false,"placeholder_time":false,"size":"","start_id":"","class":"","class-time":"","calendar":{"cols":1,"rows":1,"dateCursor":"pointer"},"valueViewDate":"","valueViewTime":"","formatDate":"d\/m\/Y","formatTime":"H:i","checkDateOnLoad":false,"autocomplete":null}`	{"name":"Justificatif3","label":"Parcourir...","required":false,"typeMimes":{"image\/jpeg":["jpg","jpeg"],"image\/gif":["gif"],"image\/png":["png"],"application\/pdf":["pdf"],"application\/x-download":["pdf"],"application\/download":["pdf"],"application\/octet-stream":["pdf"],"application\/octetstream":["pdf"]},"size_max":"5M","multiple":false,"increment":false,"valueIsHtml":true,"label_files":"Parcourir ([total] fichier[s])","id":"662d9a1b7cc02","transmit":true,"label_max":"","title":"Le poids d'un fichier \u00e0 transmettre ne peut exc\u00e9der 5M. Les formats de fichier accept\u00e9s sont jpg, jpeg, gif, png, pdf.","class":"","value":false,"html":"","initializeJS":true,"size_max_byte":5242880,"button":{"value":"Parcourir...","title":"Le poids d'un fichier \u00e0 transmettre ne peut exc\u00e9der 5M. Les formats de fichier accept\u00e9s sont jpg, jpeg, gif, png, pdf.","class":"","id":"662d9a1b7cc02"}}
			`{"name":"Date-naissance4","value":"","required":false,"disabled":false,"showTime":false,"rows":1,"cols":1,"title":false,"showDate":true,"preloadCalendar":false,"id":null,"placeholder_date":false,"placeholder_time":false,"size":"","start_id":"","class":"","class-time":"","calendar":{"cols":1,"rows":1,"dateCursor":"pointer"},"valueViewDate":"","valueViewTime":"","formatDate":"d\/m\/Y","formatTime":"H:i","checkDateOnLoad":false,"autocomplete":null}`	{"name":"Justificatif4","label":"Parcourir...","required":false,"typeMimes":{"image\/jpeg":["jpg","jpeg"],"image\/gif":["gif"],"image\/png":["png"],"application\/pdf":["pdf"],"application\/x-download":["pdf"],"application\/download":["pdf"],"application\/octet-stream":["pdf"],"application\/octetstream":["pdf"]},"size_max":"5M","multiple":false,"increment":false,"valueIsHtml":true,"label_files":"Parcourir ([total] fichier[s])","id":"662d9a1b7d613","transmit":true,"label_max":"","title":"Le poids d'un fichier \u00e0 transmettre ne peut exc\u00e9der 5M. Les formats de fichier accept\u00e9s sont jpg, jpeg, gif, png, pdf.","class":"","value":false,"html":"","initializeJS":true,"size_max_byte":5242880,"button":{"value":"Parcourir...","title":"Le poids d'un fichier \u00e0 transmettre ne peut exc\u00e9der 5M. Les formats de fichier accept\u00e9s sont jpg, jpeg, gif, png, pdf.","class":"","id":"662d9a1b7d613"}}
			`{"name":"Date-naissance5","value":"","required":false,"disabled":false,"showTime":false,"rows":1,"cols":1,"title":false,"showDate":true,"preloadCalendar":false,"id":null,"placeholder_date":false,"placeholder_time":false,"size":"","start_id":"","class":"","class-time":"","calendar":{"cols":1,"rows":1,"dateCursor":"pointer"},"valueViewDate":"","valueViewTime":"","formatDate":"d\/m\/Y","formatTime":"H:i","checkDateOnLoad":false,"autocomplete":null}`	{"name":"Justificatif5","label":"Parcourir...","required":false,"typeMimes":{"image\/jpeg":["jpg","jpeg"],"image\/gif":["gif"],"image\/png":["png"],"application\/pdf":["pdf"],"application\/x-download":["pdf"],"application\/download":["pdf"],"application\/octet-stream":["pdf"],"application\/octetstream":["pdf"]},"size_max":"5M","multiple":false,"increment":false,"valueIsHtml":true,"label_files":"Parcourir ([total] fichier[s])","id":"662d9a1b7e033","transmit":true,"label_max":"","title":"Le poids d'un fichier \u00e0 transmettre ne peut exc\u00e9der 5M. Les formats de fichier accept\u00e9s sont jpg, jpeg, gif, png, pdf.","class":"","value":false,"html":"","initializeJS":true,"size_max_byte":5242880,"button":{"value":"Parcourir...","title":"Le poids d'un fichier \u00e0 transmettre ne peut exc\u00e9der 5M. Les formats de fichier accept\u00e9s sont jpg, jpeg, gif, png, pdf.","class":"","id":"662d9a1b7e033"}}

*Justificatif conjoint : livret de famille, acte de mariage/pacs, justificatif de vie commune (facture au deux noms)

Justificatif enfant : acte de naissance ou livret de famille complet

Si votre conjoint travaille à la CARSAT, veuillez indiquer son matricule :

Veuillez joindre un RIB afin d'obtenir le remboursement des prestations : {"name":"RIB","label":"Parcourir...","required":false,"typeMimes":{"image\/jpeg":["jpg","jpeg"],"image\/gif":["gif"],"image\/png":["png"],"application\/pdf":["pdf"],"application\/x-download":["pdf"],"application\/download":["pdf"],"application\/octet-stream":["pdf"],"application\/octetstream":["pdf"]},"size_max":"5M","multiple":false,"increment":false,"valueIsHtml":true,"label_files":"Parcourir ([total] fichier[s])","id":"662d9a1b7e6fc","transmit":true,"label_max":"","title":"Le poids d'un fichier \u00e0 transmettre ne peut exc\u00e9der 5M. Les formats de fichier accept\u00e9s sont jpg, jpeg, gif, png, pdf.","class":"","value":false,"html":"","initializeJS":true,"size_max_byte":5242880,"button":{"value":"Parcourir...","title":"Le poids d'un fichier \u00e0 transmettre ne peut exc\u00e9der 5M. Les formats de fichier accept\u00e9s sont jpg, jpeg, gif, png, pdf.","class":"","id":"662d9a1b7e6fc"}}

Certifie exact, le {"name":"Date-jour","value":"","required":true,"disabled":false,"showTime":false,"rows":1,"cols":1,"title":false,"showDate":true,"preloadCalendar":false,"id":null,"placeholder_date":false,"placeholder_time":false,"size":"","start_id":"","class":"","class-time":"","calendar":{"cols":1,"rows":1,"dateCursor":"pointer"},"valueViewDate":"","valueViewTime":"","formatDate":"d\/m\/Y","formatTime":"H:i","checkDateOnLoad":false,"autocomplete":null}

CSE Carsat PL

Nouvel embauché CARSAT

Fiche de renseignements des agents

"CARSAT"

*Justificatif conjoint : livret de famille, acte de mariage/pacs, justificatif de vie commune (facture au deux noms)

Justificatif enfant : acte de naissance ou livret de famille complet