Training Manual on Human Rights Monitoring - Appendix I to Chapter XXIV: United Nation Personal Data Form
Please fill out this form immediately
and return it to the Chief of Operations for transmission to the Designated
Official.
Thank you.
1. NAME: ........................................................................................................................
2. AGENCY:....................................................................................................................
3. LAISSEZ-PASSER N°........................................... EXPIRY DATE: .........................
NATIONAL PASSPORT N°.................................. EXPIRY DATE: .........................
4. NATIONALITY: .........................................................................................................
5. BLOOD TYPE: .......................................... RHESUS: ...................................
6. UNUSUAL MEDICAL CONDITION/NEEDS/ALLERGIES: .....................................
7. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY :
NAME: ........................................................................................................................
ADDRESS: ..................................................................................................................
TELEPHONE N°: ........................................................................................................
8. ADDRESS IN COUNTRY OF OPERATIONS:.........................................................
9. DIRECTIONS FOR LOCATING THAT LOCATION:HOTEL/RESIDENCE:.................................................................................................
10. ARRIVAL DATE: .......................................................................................................
11. ESTIMATED DEPARTURE DATE: ..........................................................................
12. I will keep the Designated Official informed about any changes of address/telephone during my stay in the country of operations.
Signature.........................................................Dated: ...................................At:......................