Your Name/Name
Address
Postal Code/City
MDPH
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]
Draw your signature