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Emergency Contact Form

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Abish John
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38 views1 page

Emergency Contact Form

Uploaded by

Abish John
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Headquarter: 1210, Citadel Tower, Business Bay, Dubai, UAE

PO Box: 9360

Istanbul Office: 2/4, Zorlu Centre Beşiktaş İstanbul, Türkiye


PO Box: 34340

EMPLOYEE INFORMATION
Department:
Employee Name:
First, Middle, Surname Direct Manager:
PERSONAL INFORMATION

Employee No: Joining Date:


Work No: Work E-Mail:
Personal No: Personal E-Mail:
UAE Address: Emirate:
Street, Building, City, ZIP Code

Home Address: Country:


Street, Building, City, ZIP Code

Single
Married Spouse Name:
Marital Status:
Divorced (If married)

Widow
Next of Kin: Phone No:
(Primary Contact) First, Middle, Surname

Address: Country:
Street, Building, City, ZIP Code

Relationship: E-Mail:
EMERGENCY CONTACTS
Please list two people (in priority order) who could be contacted in case of emergency.
Phone No:
CONTACT 2 CONTACT 1

Name: (Include country code)

Relationship: Alternate Phone No:


(Include country code)

UAE Address: Emirate:


Street, Building, City, ZIP Code

Name: Phone No:


(Include country code)

Relationship: Alternate Phone No:


(Include country code)

Home Address: Country:


Street, Building, City, ZIP Code

In the event that I need emergency services:


(Check one)
I give consent to medical treatment by any professional licensed to provide health care services.
I do not consent to any type of medical treatment.
I have voluntarily provided the above contact information and authorized ROBUST ENERGY SOLUTIONS FZCO and
its representative to contact any of the above on my behalf in the event of an emergency.

_________________________
Employee Name and Signature
Date:

Note: If any of the information listed above changes, please submit a revised form. Version - 04/2024

Factory: B34BH 531 St., Mina Jebel Ali, Jebel Ali +971 48 347 663
Freezone, Dubai, UAE www.robustess.com

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