Spouse Declaration Form for CNSS
Translated by
ScribdTranslationsSpouse Declaration Form for CNSS
Translated by
ScribdTranslationsDECLARATION OF A SPOUSE
OF WORKER (1)
The areas marked with * are reserved for the CNSS. The dates are in DD MM YYYY format
I - I D E N T I F I CAT I O N O F ( O FT H E ) C O N J O I N T ( E )
Birth name
First names
Date of birth Sexe : F M
Place of birth
Father: Name First names
Mère : Nom First names
Phone Number
Profession Code *
Date of effect of declaration *
Code link * Link date *
Spouse's insurance number (if spouse is an employee and/or affiliated with CNSS)
Has the partner ever been declared by another worker? Yes No If yes, specify:
Insurance number and/or name of the declarant
In this case, the reason for this statement: Divorce with the first declarant Death of the first declarant Other reason
I I - I D E N T I F I CAT I O N O FT H EAS S U R E D
Insurance No.
Name and first names
I I I - CIVIL STATUS FILE ATTACHING MANDATORY REQUIREMENT
Marriage certificate number or Birth Certificate No.
Date and place of the wedding: the à
Date and place of declaration: on à
Made in the
Worker's signature
Fill out a form per partner in the case of multiple partners.
You can download this form online at [Link] and fill it out in uppercase letters and with no overwrites.
But preferably, you can directly make your request at [Link] by registering.
SIEGE Maritime Division Gulf Maritime Gulf Division Plateaus Division Central Division Division of the Kara Savannah Division
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