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Sending your sick note to your employer by fax

Part 3 of the sick note (arrêt de travail) must reach your employer within 48 hours. This template goes with it: fill it in, attach part 3, and send everything in a single fax.

In short

Part 3 of the French sick note is meant for the employer: send it within 48 hours, unless your collective agreement sets another deadline. A fax works for the employer, but not for the health insurance fund: since 1 September 2025 it accepts neither photocopies nor scans. Parts 1 and 2 go by post on the original form, or are sent electronically by the doctor.

Fill in the template

Everything happens in your browser: nothing is sent or stored until you submit the sending form.

This letter is addressed to a French organisation, so it is written in French and the PDF will stay in French. Please fill in the fields in French, using Latin characters.

Your details

One address line per line.

So the recipient can reply.

Recipient

In French, for example "Ressources humaines".

Printed on the letter and carried over to the sending form. Check it on a letter from the organisation or in the site's directory.

Letter content

Place and date

Where you are writing from, as in "À Lyon, le…".

Defaults to today.

Signature and attachments
Optional. A sharp photo on a white background, PNG or JPEG. Without an image, space is left to sign by hand.
Optional. PDF, JPEG or PNG: they are placed after the letter, in the same document.

One-page document: free, unlimited sending.

To generate the PDF, fill in: Your first and last name, Your postal address, Employer, Start of sick leave, End of sick leave (inclusive), Town or city.

Need proof? When sending, the optional PDF acknowledgment of receipt (€3.99 incl. VAT) records the date and transmission of the fax. Keep it with a copy of the letter.

Letter preview

The letter exactly as it will be sent. Fields still to fill in are highlighted.

[Prénom Nom][Adresse postale]

[Organisme destinataire]

À [Ville], le [date]

Courrier envoyé par télécopie

Objet : Transmission de mon arrêt de travail

Madame, Monsieur,

Je vous informe que je suis en arrêt de travail, sur prescription médicale, du [date de début] au [date de fin] inclus.

Vous trouverez ci-joint le volet n° 3 de l’avis d’arrêt de travail, destiné à l’employeur.

Les volets n° 1 et n° 2 sont adressés séparément à ma caisse d’assurance maladie.

Je vous remercie d’établir l’attestation de salaire nécessaire au versement de mes indemnités journalières.

Je vous prie d’agréer, Madame, Monsieur, l’expression de mes salutations distinguées.

[Prénom Nom]

Pièce jointe :

  • – Volet n° 3 de l’avis d’arrêt de travail

How to fill it in

  1. 1

    Find part 3

    It is the copy intended for the employer. If your doctor sent the sick note electronically, it is the only part you receive, on paper or electronically.

  2. 2

    Fill in the letter

    Enter the start and end dates of the sick leave as shown on the form, and say whether it is an extension.

  3. 3

    Attach part 3

    Add a legible photo or scan of part 3 under "Attachments": it is placed after the letter, in the same PDF.

  4. 4

    Send within 48 hours

    Fax the document to the HR department. The PDF acknowledgment of receipt proves the sending date if the deadline is disputed.

Check before sending

  • No fax to the CPAM

    Since 1 September 2025, the French health insurance fund no longer accepts photocopies or scans of sick notes: only the original secure paper form (parts 1 and 2, by post) and the note sent electronically by the doctor count.

  • 48 hours, on both sides

    48 hours for the employer, unless a collective agreement says otherwise; 48 hours for the health insurance fund too. If you send late to the fund again within two years, your daily allowances can be cut by half.

  • Extensions: same procedure

    Each extension is sent in the same way and within the same deadlines: part 3 to the employer, parts 1 and 2 to the health insurance fund.

  • Several employers

    If you work for several employers and the sick leave covers all your jobs, inform each of them and send each one a copy of part 3.

Template provided for information, checked on October 8, 2026 against the official sources below. It does not replace advice from a legal professional, nor the terms of your contract.

Official sources (in French)

Send this document by fax

A one-page fax is free and unlimited, with no sign-up. From two pages, sending costs €3.99 incl. VAT. To prove you sent it, add the PDF acknowledgment of receipt (€3.99 incl. VAT).

Fill in the template

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