Your Name/Name

Address

Postal Code/City

MDPH

Address

Postal Code/City

Done[your city], on [précate the date].

 

Object : Application for disability card;

 

Madam, Sir,

Currently [state your status permanent disability of;at least 80% / disabled of 3ème catégorie / classified in group 1 or 2 of the Aggir grid], I wish to benefit from the mobilité inclusion invalidité card.

You will find attached the Cerfa 13788*01 form dûment filled out and accompanied by a medical certificate of less than 6 months and a copy of my identity document.

Waiting for this, please accept, Madam, Sir, my best regards.

 

[Your signature]

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