PERSONAL INFORMATION & CONTACTS

My emergency profile

Mes informations et contacts en cas d’urgence

Basic details and the people to contact in France and Palestine.

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France

Mon profil en France

Call first En priorité[Name and phone]
Backup À défaut[Name and phone]

Basic information Informations personnelles

Full legal name
[Enter name]
Date of birth and nationality
[Enter details]
My phone and email
[Enter details]
Address in France
[Enter full address]

Identification Identifiants

Passport
[Number and issuing country]
French residence permit
[Number, if applicable]
Social security number
[Enter number]
Health insurance or mutuelle
[Provider and membership number]

People to contact Personnes à contacter

  • Family

    [Name and relationship]

    [Phone with country code]

    [Email or alternative number]

  • Close friend

    [Name]

    [Phone with country code]

    [Email or alternative number]

  • Local contact

    [Name]

    [Phone with country code]

    [Email or alternative number]

  • Medical representative

    [Name, if formally designated]

    [Phone with country code]

    [Email or alternative number]

  • Main supervisor

    [Name]

    [Phone with country code]

    [Email]

  • Co supervisor

    [Name]

    [Phone with country code]

    [Email]

  • Research unit secretariat

    [Name and unit]

    [Phone with country code]

    [Email]

Palestine

Mon profil en Palestine

Call first En priorité[Name and phone]
Backup À défaut[Name and phone]

Basic information Informations personnelles

Full legal name
[Enter name]
Date of birth and nationality
[Enter details]
My phone and email
[Enter details]
Address in Palestine
[Enter full address]

Identification Identifiants

Palestinian identity number
[Number, if applicable]
Passport
[Number and issuing country]
Health insurance or social security
[Provider and number, if applicable]

People to contact Personnes à contacter

  • Family contact 1

    [Name and relationship]

    [Phone with country code]

    [Email or alternative number]

  • Family contact 2

    [Name and relationship]

    [Phone with country code]

    [Email or alternative number]

  • Close friend 1

    [Name]

    [Phone with country code]

    [Email or alternative number]

  • Close friend 2

    [Name]

    [Phone with country code]

    [Email or alternative number]

  • Local contact

    [Name]

    [Phone with country code]

    [Email or alternative number]

  • Medical representative

    [Name, if formally designated]

    [Phone with country code]

    [Email or alternative number]

  • Other contact

    [Name and role]

    [Phone with country code]

    [Email or alternative number]