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Civilité/Civility*
Mme/Mrs
M./Mr
Prénom/Name ou/or Grade*
Nom/Surname*
Date de naissance/Date of birth*
Année
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
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1973
1974
1975
1976
1977
1978
1979
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1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
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2005
2006
2007
2008
2009
2010
2011
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2014
2015
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2017
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2019
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2021
2022
2023
2024
Mois
Janvier
Février
Mars
Avril
Mai
Juin
Juillet
Août
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Jour
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Ville de naissance/City of birth*
Nationalité/Nationality*
Société/Company name*
Fonction/Position*
Pays/Country*
Pays
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua/Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei Daruss.
Bulgaria
Burkina-Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
External Territories of Australia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guayana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong SAR, China
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldavia
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Ter
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
R.D. Congo
Reunion
Romania
Ruanda
Russian Fed.
S.Tome,Principe
Samoa, America
San Marino
Saudi Arabia
Senegal
Serbian
Sierra Leone
Singapore
Slovakia
Slovenia
Smaller Territories of Chile
Smaller Territories of the UK
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
St Kitts&Nevis
St. Helena
St. Lucia
St. Vincent
St.Martin
St.Pier,Miquel.
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan, China
Tajikstan
Tanzania
Thailand
Togo
Tokelau Islands
Tonga
Trinidad,Tobago
Tunisia
Turkey
Turkmenistan
Turksh Caicosin
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands of the United States
Wallis,Futuna
Western Samoa
Yemen
Zambia
Zimbabwe
E-mail Professionnel/Professional e-mail *
Secteur Activité/Business sector*
...
ASSOCIATIF/ASSOCIATIVE
AUTOMOBILE/CAR INDUSTRY
BIJOUTERIE JOAILLERIE PARFUMERIE LUXE/JEWELERY PERFUMERY LUXURY
CORPS DIPLOMATIQUE/DIPLOMATIC CORPS
CULTURE
CYBERSECURITE/CYBERSECURITY
DEFENSE (FORCES ARMEMENT ADMINISTRATION)/DEFENCE (FORCES PROCURMENT ADMINISTRATION)
DIGITAL
ENERGIE/ENERGY
ENSEIGNEMENT FORMATION/ EDUCATION TRAINING
FINANCE
HOTELLERIE/HOTEL INDUSTRY
IMMOBILER BTP/REAL ESTATE CIVIL ENGINEERING
IMPORT EXPORT
INDUSTRIES DE DEFENSE ET SECURITE/INDUSTRY DEFENSE OR SECURITY
INDUSTRIES (HORS DEFENSE ET SECURITE)/INDUSTRY (EXCLUDING DEFENCE & SECURITY)
JURIDIQUE/LAW
LOGISTIQUE MAINTENANCE/LOGISTICS MAINTENANCE
LOISIRS ATTRACTIONS EVENEMENTIEL/LEISURE ATTRACTIONS EVENTS
MEDECINE SANTE/MEDECINE HEALTH
ORGANISMES GOUVERNEMENTAUX (HORS DEFENSE ET SECURITE)/GOVERNMENT (EXCLUDING DEFENCE & SECURITY)
ORGANISMES PROFESSIONNELS/PROFESSIONAL ORGANIZATION
ORGANISMES PUBLICS ET NON GOUVERNEMENTAUX/PUBLIC ORGANISATIONS
PROCUREMENT ACHAT/PROCUREMENT PURCHASE
RECHERCHE/RESEARCH
RESSOURCES HUMAINES/HUMAN RESSOURCES
SECURITE PRIVEE/PRIVATE SECURITY
SECURITE PUBLIQUE (POLICE GENDARMERIE)/HOME LAND DEFENCE (POLICE NATIONAL GUARD)
SERVICE D’INCENDIE ET SECOURS/HOME LAND SECURITY
SECURITE CIVILE/SECURITY FORCES
SERVICE INGENIERIE CONSULTING/SERVICE ENGINEERING CONSULTING
SPORTS
THINK TANK
TRANSPORTS
AUTRE/OTHER
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NON je n'en ai pas besoin/NO I don't need it
OUI je souhaite une Attestation/YES I need a Certificate
Passeport N°/Passport N°
Date d'expiration/Date of expiry
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