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:.........................................................

HOTEL/RESIDENCE:.................................................................................................

9. DIRECTIONS FOR LOCATING THAT LOCATION:

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:......................




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