Your First name/Last name

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MDPH

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Done in [your city], on [specify the date].

Subject: Application for a disability card

Madam, Sir,

Currently [indicate your situation: permanent disability of at least 80% / 3rd category invalid / classified in group 1 or 2 of the Aggir scale], I would like to obtain the mobility inclusion disability card.

Please find enclosed the Cerfa form 13788*01 duly completed, along with a medical certificate less than 6 months old and a copy of my identity document.

While awaiting your reply, please accept, Madam, Sir, the expression of my best regards.

[Your signature]