ࡱ>  @ bjbj)) hKzKz,3FFF8G\dHI4KvZ.ZZZ[_<a ؁ځځځځځځ$RQ*f[[*f*fZZlll*f^ZZ؁l*f؁lldrX tZ(K 3"MFfs(4t 0Is(߆g\߆P t߆ t(bdldeebbb$CFrlFINSTRUCTIONS Please answer each question clearly and completely. TYPE OR PRINT LEGIBLY. Read carefully and follow all directions.UNITED NATIONS PERSONAL HISTORYDo not Write in This SpaceFamily name  FORMTEXT      First name  FORMTEXT      Middle name  FORMTEXT      Maiden name, if any  FORMTEXT      Date of (day/month/yr) Birth  FORMTEXT      Place of birth  FORMTEXT      Nationality(ies) at birth  FORMTEXT      Present Nationality(ies)  FORMTEXT      Sex  FORMTEXT      Height  FORMTEXT      Weight  FORMTEXT      9. Marital Status: Single  FORMCHECKBOX  Married  FORMCHECKBOX  Separated  FORMCHECKBOX  Widow(er)  FORMCHECKBOX  Divorced  FORMCHECKBOX Entry into United Nations service might require assignment to any area of the world in which the United Nations might have responsibilities. (a) Are there any limitations on your ability to perform in your prospective field of work? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (b) Are there any limitations on your ability to engage in all travel? YES  FORMCHECKBOX  NO  FORMCHECKBOX Permanent address  FORMTEXT       Telephone No. ( FORMTEXT       )  FORMTEXT      Present address  FORMTEXT       Telephone/Fax No. (  FORMTEXT       )  FORMTEXT      Office Telephone No. (  FORMTEXT       )  FORMTEXT      Office Fax No. ( FORMTEXT       )  FORMTEXT       E-mail:  FORMTEXT      15. Do you have any dependent children? YES  FORMCHECKBOX  NO  FORMCHECKBOX  If the answer is  yes , give the following information:Name of ChildrenDate of Birth (day/mo/year)Place of BirthNationalityGender  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      15. (a) Name of Spouse  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Have you taken up legal permanent residence status in any country other than that of your nationality? YES  FORMCHECKBOX  NO  FORMCHECKBOX  If answer is  yes , which country?  FORMTEXT       17. Have you taken any legal steps towards changing your present nationality? YES  FORMCHECKBOX  NO  FORMCHECKBOX  If answer is  yes , explain fully:  FORMTEXT       18. Are any of your relatives employed by a public international organization? YES  FORMCHECKBOX  NO  FORMCHECKBOX  If answer is  yes , give the following information:NAMERelationshipName of International Organization FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      What is your preferred field of work?  FORMTEXT      Would you accept employment for less than six months? YES  FORMCHECKBOX  NO  FORMCHECKBOX Have you previously submitted an application for employment and/or undergone any tests with U.N.? YES  FORMCHECKBOX  NO  FORMCHECKBOX  If so, when?  FORMTEXT       KNOWLEDGE OF LANGUAGES. What is your mother tongue?  FORMTEXT       OTHER LANGUAGESREADWRITESPEAKUNDERSTANDEasilyNot EasilyEasilyNot EasilyFluentlyNot FluentlyEasilyNot Easily FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX For clerical grades only Indicate speed in words per minuteList any office machines or equipment and computer programmes you use.  FORMTEXT      EnglishFrenchOther languages FORMTEXT       FORMTEXT      Typing FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    Shorthand FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     EDUCATION, Give full details  N.B. Please give exact titles of degrees in original language. Please do not translate or equate to other degrees. A. University or equivalentNAME, PLACE AND COUNTRY Please give complete address.ATTENDED FROM/TODEGREES and ACADEMIC DISTINCTIONS OBTAINEDMAIN COURSE OF STUDYMonth/YearMonth/Year FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       B. SCHOOLS OR OTHER FORMAL TRAINING OR EDUCATION FROM AGE 14 (e.g., high school, technical school or apprenticeship)NAME, PLACE AND COUNTRY Please give complete address.TYPEYEARS ATTENDEDCERTIFICATES OR DIPLOMAS OBTAINEDFROMTO FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT    ( , N     4 6 8 B D F n p ̰̰̰̰ h$}CJj*h$}5Uj"*h$}5Uj)h$}5Ujh$}5UmHnHuj )h$}5Ujh$}5Ujh$}5CJU h$}5CJh$}5CJEH h$}6 h$}5h$}3 * , N [Q  & F $Ifkd5($$IflFk"*0    4 la$If $$Ifa$ $$Ifa$$If$If    F n [Q  & F $Ifkd>+$$Ifl4 \c *    04 laf4$If$If  4 6 8 B D F z |      ( * , . < > @ T V X b d f t v ȻȮȡȔȐ~ȋj0h$}5U h$}6h$}ju.h$}5Uj-h$}5UjY-h$}5Uj,h$}5U h$}5 h$}CJ h$}5CJjh$}5UmHnHujh$}5UjC,h$}5U1  F z  , $If & F $If h$If^h , . < f t TJDJD>D$If$If  & F $Ifkd/$$Ifl4pr/\!*04 laf4v " > @ B F r t  -./0˄wj!4h$}5U h$}CJj2h$}5UjJ2h$}5Uj1h$}5Ujb1h$}5Uj0h$}5Uh$} h$}6jh$}5UmHnHujh$}5Ujx0h$}5U h$}5.Jzpjj$If  & F$Ifkd23$$Ifl4pF8$ *]!0    4 laf4089GHIJ  .0DFHRTZ\prt~xj7h$}5Ujv7h$}5Uj7h$}5Ujh$}5UmHnHuj6h$}5U h$}6j}5h$}5Uj 5h$}5U h$}CJj4h$}5U h$}5jh$}5Uh$}/Hr  & F$If$If  & F$If^kd5$$Ifl4**04 laf4    "68:DFHrvx   468BDXZnݾj};h$}5Uj;h$}5Uj9h$}5UjN9h$}5U h$}6j8h$}5Ujb8h$}5Uh$} h$}5jh$}5Ujh$}5UmHnHu5F|vvlff$If  & F$If$Ifkd::$$Ifl4F*`j` 0    4 laf4npr|~"$@BDFLN`bdxz|̲̿֞rbrjf@h$}56CJU$jh$}56CJUmHnHuj?h$}56CJUh$}56CJjh$}56CJU h$}56j=h$}5Uj:=h$}5U h$}5 h$}6h$}jh$}5UmHnHujh$}5Uj;h$}5U&zt$Ifkd]<$$Ifl4F* j  0    4 laf48P` $$Ifa$^kd">$$Ifl4**04 laf4`b*TNEEEE $$Ifa$$Ifkd>$$Ifl4r y#* p04 laf4&(*,.BDFPRTVjlnxz|~zjjDh$}56CJUjDh$}56CJUj}Ch$}56CJU h$}6jAh$}56CJUjtAh$}56CJU h$}6CJ$jh$}56CJUmHnHuj@h$}56CJUh$}56CJjh$}56CJU)*,T|TNEEEE $$Ifa$$IfkdbB$$Ifl4r y#* p04 laf4  468BDFH\^`jlnpzjjHh$}56CJUj2Hh$}56CJUjGh$}56CJUj$Gh$}56CJU h$}6jEh$}56CJU h$}6CJ$jh$}56CJUmHnHujEh$}56CJUh$}56CJjh$}56CJU)FnTNEEEE $$Ifa$$Ifkd F$$Ifl4r y#* p04 laf4 &(*468:NPR\^`bvϿغϪϚϊzjQLh$}56CJUjKh$}56CJUjCKh$}56CJUjJh$}56CJU h$}6j:Ih$}56CJUh$}56CJ h$}6CJ$jh$}56CJUmHnHujh$}56CJU*8`TNEEEE $$Ifa$$IfkdI$$Ifl4r y#* p04 laf4vxz&(*,@BDNPRT⻫⻛⻋{kjpPh$}56CJUjOh$}56CJUjhOh$}56CJUjNh$}56CJUjZNh$}56CJUh$}56CJh$} h$}6CJ$jh$}56CJUmHnHujh$}56CJUjLh$}56CJU**RTNEEEE $$Ifa$$Ifkd?M$$Ifl4r y#* p04 laf4RT|TNEEEE $$Ifa$$IfkdP$$Ifl4r y#* p04 laf4TVjlnxz|~  4RThzpk h$}5jh$}5U h$}6j Th$}56CJUjSh$}56CJUjSh$}56CJU h$}6CJjyRh$}56CJU$jh$}56CJUmHnHujQh$}56CJUh$}56CJjh$}56CJU'RzTNE<<< $$Ifa$ $$Ifa$$IfkduT$$Ifl4r y#* p04 laf4hjlvxz|  $ɝɘɝɁqɝɁaɝɁ֘jWh$}56CJUj"Wh$}56CJU h$}6CJjVh$}56CJU h$}6$jh$}56CJUmHnHujVh$}56CJUh$}56CJjh$}56CJUh$}jh$}5UmHnHujh$}5UjUh$}5U&^KA;$If  & F$IfkdX$$Ifl4Or y#* p04 laf4 $$Ifa$$&(:<XZ\^pZ\pۻqaұYjh$}Uj[h$}56CJUjD[h$}56CJU h$}6jh$}5UmHnHuj5Zh$}5U h$}5jh$}5Uh$} h$}CJ h$}6CJjYh$}56CJUh$}56CJ h$}6CJjh$}56CJUjMYh$}56CJU"5^kd\$$Ifl4?**04 laf4$If$If^kdZ$$Ifl4**04 laf4prt~@HJfhj~"*,ȻȻԈvgػWj`h$}56CJUjh$}5UmHnHuj_h$}5U h$}5jh$}5Uj]h$}56CJUj;]h$}56CJUh$}56CJjh$}56CJU h$}6CJ h$}6h$} h$}CJjh$}UmHnHujh$}Uj,\h$}U" ",F $$Ifa$ $$Ifa$^kd#^$$Ifl4]**04 laf4$If ztnn$If$Ifkd^$$Ifl4F*Y0    4 laf4     " , . 0 2 F H J T V X Z n p r | ~ ټ{kf h$}6jbh$}56CJUjrbh$}56CJU h$}CJjh$}5UmHnHujah$}5U h$}5jh$}5Uh$}j`h$}56CJUh$}56CJ h$}6CJjh$}56CJU$jh$}56CJUmHnHu#  0 X ztnn$If$Ifkda$$Ifl4F*Y0    4 laf4 ztnn$If$Ifkdzc$$Ifl4F*Y0    4 laf4 H!J!^!`!b!l!n!p!!!!""" ""ǾǛǔǾǛǔ{vi{v\vjgh$}5Ujfh$}5U h$}5 h$}6h$}jUeh$}56CJU h$}6CJ$jh$}56CJUmHnHujdh$}56CJUh$}56CJjh$}56CJU h$}CJjh$}5UmHnHujh$}5UjMdh$}5U$ H!p!zpj$If  & F$Ifkde$$Ifl4F*Y0    4 laf4p!r!!@"## w$If^w  & F$If^kdg$$Ifl4p**04 laf4"":"<">"@" ###0#2#4#6#H#J#f#h#j#r#t############*$,$@$B$D$N$P$R$T$ǾǾǾǾǾ{uǾe{jjh$}56CJU h$}CJ$jh$}56CJUmHnHujih$}56CJUj ih$}56CJUjhh$}56CJUh$}56CJjh$}56CJU h$}6CJ h$}6h$}j#hh$}5U h$}5jh$}5U'##R$T$x  !$If  & F$Ifqkdi$$Ifl4F0*:04 laf4T$V$v$$$$$ $$Ifa$^kdk$$Ifl4**04 laf4T$V$$$$J%L%N%b%d%f%p%r%t%v%%%%%%%%%%%%%%%%%&&&&"&$&&&ۯҟҏo_jrh$}56CJUjrh$}56CJUjqh$}56CJUj1qh$}56CJUjph$}56CJU$jh$}56CJUmHnHujGph$}56CJUh$}56CJjh$}56CJU h$}6CJh$} h$}6CJ h$}6%$$$$$$$ %&%TKKKKKKK $$Ifa$kdk$$Ifl4r=I!*`rp04 laf4&%4%J%L%t%%%%&(&L&N&r&&&&&','P't'''''' (FfFfv$IfFf[n $$Ifa$&&(&*&F&H&J&N&P&l&n&p&r&t&&&&&&&&&&&&&&&&&&&'''' '&'{kjyh$}56CJUjyh$}56CJU$jh$}56CJUmHnHujyh$}56CJUh$}jsh$}56CJUjush$}56CJUjsh$}56CJUh$}56CJjh$}56CJU h$}6CJ$&'('*','.'J'L'N'P'R'n'p'r't'v''''''''''''''''''''( (ҲҢҒ҂}mZ$jh$}56CJUmHnHujh$}56CJU h$}6j|h$}56CJUj>|h$}56CJUj{h$}56CJUjV{h$}56CJUjzh$}56CJUh$}56CJ h$}6CJjh$}56CJUjnzh$}56CJU# ( ((*(,(.(0(2(N(P(R(T(V(r(t(v(x(z(((((((((((((((())) ) )()rjh$}56CJUjwh$}56CJUjh$}56CJUjh$}56CJUjh$}56CJUjh$}56CJUj3h$}56CJUh$}56CJjh$}56CJU h$}6CJ& (0(T(x((((( ).)0)X)|)))) *0*2*V*z*|***+$If  & F$IfFf $IfFf^ $$Ifa$()*),).)0)2)F)H)J)T)V)X)Z)v)x)z)|)~))))))))))))))))** *ξΛ΋{k[jh$}56CJUjBh$}56CJUj΋h$}56CJUjZh$}56CJUjh$}56CJU$jh$}56CJUmHnHujph$}56CJUh$}56CJh$} h$}6CJjh$}56CJUjch$}56CJU# * ****,*.*2*4*P*R*T*V*X*t*v*x*z**+++++++++++++ ,,,~rcrjnh$}6CJUjh$}6CJUjh$}5UmHnHujh$}5U h$}5jh$}5Uh$} h$}6jh$}56CJUjh$}56CJUj*h$}56CJUh$}56CJjh$}56CJU h$}6CJ!++++++++~xx~x$If $$Ifa$qkd$$Ifl4p0I*`:04 laf4$If+++++,F,H,TNNNNNN$IfkdU$$Ifl4r= I*`u  :04 laf4,,,, ,4,6,8,B,D,F,H,J,X,Z,n,p,r,x,z,|,~,,,,,,,,,Ǹ||lYۅ|$jh$}56CJUmHnHujMh$}56CJUh$}56CJjh$}56CJU jh$}56UmHnHujחh$}56U h$}56jh$}56Uh$} h$}6jh$}6CJU h$}6CJjh$}6CJU!jh$}6CJUmHnHuH,J,X,|,,,A8222$If $$Ifa$kdZ$$Ifl4ֈ= I*   F/ :04 laf4,,,,,,,,,,,,,----- -"-$-&-:-<->-D-F-H-J-^-`-b-h-j-l-n-------⿯Ȫ⿚⿊zjjUh$}56CJUjߛh$}56CJUjih$}56CJUjh$}56CJU h$}6j9h$}56CJUh$}56CJ h$}6CJ$jh$}56CJUmHnHujh$}56CJUjØh$}56CJU),,,,-$-;2 $$Ifa$kd$$Ifl4Xֈ= I*F/ :04 laf4$If$-H-l-----;9kd˜$$Ifl4=ֈ= I*F/ :04 laf4$If---'/(/2/3/0 0 000$0&0(020406080L0N0P0Z0\0^0`0t0v0x00000000000000000ݮݟݐ݁rjh$}5CJUjh$}5CJUjh$}5CJUjsh$}5CJUjh$}5CJU!jh$}5CJUmHnHujah$}5CJU h$}5CJjh$}5CJU h$}CJh$} h$}6,-`.a....... / $$Ifa$\kd$$Ifl4*+04 laf4$If h$If^h & F$If / ///$/%/&/i````` $$Ifa$kd$$Ifl4\ * `* ` 04 laf4&/'/060^000VPPGPP $$Ifa$$Ifkdx$$Ifl4r *   *  04 laf40001(1P1x1TNNENN $$Ifa$$Ifkd$$Ifl4lr * *  04 laf400000000011111$1&1(1*1>1@1B1L1N1P1R1f1h1j1t1v1x1z1|1111111111111111|j!h$}5CJUjh$}5CJU h$}CJjh$}5CJUjh$}5CJUj h$}5CJU!jh$}5CJUmHnHujh$}5CJU h$}5CJjh$}5CJU/x1z11112B2TNNENN $$Ifa$$Ifkd$$Ifl4lr * *  04 laf411111112 2 22222022242>2@2B2D2>30424F4H4J4T4V4X4Z4n4p4r4|4~44444444444;͔ͯͩͅvjch$}5CJUjh$}5CJUjwh$}5CJU h$}CJ h$}CJjh$}5CJUj%h$}5CJU h$}5CJ!jh$}5CJUmHnHujh$}5CJUjh$}5CJU-B2D2<3TN$IfkdE$$Ifl4lr * *  04 laf4<3>3n33334 $$Ifa$^kd)$$Ifl4 *+04 laf44444&4,4.4i````` $$Ifa$kd$$Ifl4\ * * ` 04 laf4.404X44444VPPGGP $$Ifa$$Ifkd$$Ifl4r *  0  04 laf44444444444444445555 5"5$585:5<5F5H5J5L5`5b5d5n5p5r5t555555555;͸͚ͩ͋|j/h$}5CJUjh$}5CJUj7h$}5CJUjh$}5CJU h$}CJjgh$}5CJU h$}5CJ!jh$}5CJUmHnHujh$}5CJUjh$}5CJU+44"5J5r555TNNEEN $$Ifa$$Ifkdݯ$$Ifl4Qr * 0 04 laf4555555555555556*,.8:<>RTV`bdfz|~8:NǸǶǧǘljzjh$}5CJUjmh$}5CJUjh$}5CJUjh$}5CJUUj h$}5CJU h$}5CJ h$}CJ!jh$}5CJUmHnHujh$}5CJUjh$}5CJU,555<dTNNEEN $$Ifa$$Ifkd'$$Ifl4lr * 0 04 laf4       FORMTEXT       FORMTEXT       FORMTEXT      LIST PROFESSIONAL SOCIETIES AND ACTIVITIES IN CIVIC, PUBLIC OR INTERNATIONAL AFFAIRS  FORMTEXT      26. LIST ANY SIGNIFICANT PUBLICATIONS YOU HAVE WRITTEN (DO NOT ATTACH)  FORMTEXT      EMPLOYMENT RECORD: Starting with your present post, list in REVERSE ORDER every employment you have had. Use a separate block for each post. Include also service in the armed forces and note any period during which you were not gainfully employed. If you need more space, attach additional pages of the same size. Give both gross and net salaries per annum for your last or present post. A. PRESENT POST (LAST POST, IF NOT PRESENTLY IN EMPLOYMENT) FROMTOSALARIES PER ANNUMEXACT TITLE OF YOUR POST:  FORMTEXT      MONTH/YEAR  FORMTEXT      MONTH/YEAR  FORMTEXT      STARTING  FORMTEXT      FINAL  FORMTEXT      NAME OF EMPLOYER:  FORMTEXT      TYPE OF BUSINESS  FORMTEXT      ADDRESS OF EMPLOYER:  FORMTEXT      NAME OF SUPERVISOR  FORMTEXT      NO. AND KIND OF EMPLOYEES SUPERVISED BY YOU:  FORMTEXT      REASON FOR LEAVING  FORMTEXT      DESCRIPTION OF YOUR DUTIES:  FORMTEXT       B. PREVIOUS POSTS (IN REVERSE ORDER) FROMTOSALARIES PER ANNUMEXACT TITLE OF YOUR POST:  FORMTEXT      MONTH/YEARMONTH/YEARSTARTINGFINAL FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      NAME OF EMPLOYER:  FORMTEXT      TYPE OF BUSINESS:  FORMTEXT      ADDRESS OF EMPLOYER:  FORMTEXT      NAME OF SUPERVISOR:  FORMTEXT       NO. AND KIND OF EMPLOYEES SUPERVISED BY YOU:  FORMTEXT       REASON FOR LEAVING:  FORMTEXT      DESCRIPTION OF YOUR DUTIES FORMTEXT      FROMTOSALARIES PER ANNUMEXACT TITLE OF YOUR POST:  FORMTEXT      MONTH/YEARMONTH/YEARSTARTINGFINAL FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      NAME OF EMPLOYER:  FORMTEXT      TYPE OF BUSINESS:  FORMTEXT      ADDRESS OF EMPLOYER:  FORMTEXT      NAME OF SUPERVISOR:  FORMTEXT       NO. AND KIND OF EMPLOYEES SUPERVISED BY YOU:  FORMTEXT       REASON FOR LEAVING:  FORMTEXT      DESCRIPTION OF YOUR DUTIES FORMTEXT      FROMTOSALARIES PER ANNUMEXACT TITLE OF YOUR POST:  FORMTEXT      MONTH/YEARMONTH/YEARSTARTINGFINAL FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      NAME OF EMPLOYER:  FORMTEXT      TYPE OF BUSINESS:  FORMTEXT      ADDRESS OF EMPLOYER:  FORMTEXT      NAME OF SUPERVISOR:  FORMTEXT      NO. AND KIND OF EMPLOYEES SUPERVISED BY YOU:  FORMTEXT       REASON FOR LEAVING:  FORMTEXT      DESCRIPTION OF YOUR DUTIES FORMTEXT       28. HAVE YOU ANY OBJECTIONS TO OUR MAKING INQUIRIES OF YOUR PRESENT EMPLOYER? YES  FORMCHECKBOX  NO  FORMCHECKBOX  29. ARE YOU NOW OR HAVE YOU EVER BEEN A CIVIL SERVANT IN YOUR GOVERNMENT S EMPLOY? YES  FORMCHECKBOX  NO  FORMCHECKBOX  If answer is  yes , WHEN?  FORMTEXT      REFERENCES: List three persons, not related to you, and are not current United Nations staff members, who are familiar with your character and qualifications. Do not repeat names of supervisors listed under Item 27.FULL NAMEFULL ADDRESSBUSINESS OR OCCUPATION FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      STATE ANY OTHER RELEVANT FACTS. INCLUDE INFORMATION REGARDING ANY RESIDENCE OUTSIDE THE COUNTRY OF YOUR NATIONALITY.  FORMTEXT      32. HAVE YOU EVER BEEN ARRESTED, INDICTED, OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING, OR CONVICTED, FINED OR IMPRISONED FOR THE VIOLATION OF ANY LAW (excluding minor traffic violations)? YES  FORMCHECKBOX  NO  FORMCHECKBOX  If  yes , give full particulars of each case in an attached statement.  FORMTEXT      33. OTHER AGENCIES OF THE UNITED NATIONS SYSTEM MAY BE INTERESTED IN OUR APPLICANTS. DO YOU HAVE ANY OBJECTION TO YOUR PERSONAL HISTORY FORM BEING MADE AVAILABLE TO THEM? YES  FORMCHECKBOX  NO  FORMCHECKBOX  34. I certify that the statements made by me in answer to the foregoing questions are true, complete and correct to the best of my knowledge and belief. I understand that any misrepresentation or material omission made on a Personal History form or other document requested by the Organization renders a staff member of the United Nations liable to termination or dismissal. DATE (day, month, year)  FORMTEXT      SIGNATURE:N.B. You will be requested to supply documentary evidence which supports the statements you have made above. Do not, however, send any documentary evidence until you have been asked to do so by the Organization and, in any event, do not submit the original texts of references or testimonials unless they have been obtained for the sole use of the Organization.  PAGE  PAGE 1 PAGE  P.11 (3-00)-E 8`TJD$If & F$Ifkde$$Ifl4r * 0 04 laf4NPR\^` "L*,@BDNPjlͱǪ͛͌}njh$}5CJUjh$}5CJUj h$}5CJUjݹh$}5CJU h$}>*CJjEh$}5CJU h$}6CJ h$}CJ h$}5CJ!jh$}5CJUmHnHujh$}5CJUjIh$}5CJU+`b$&8;1 & F$If^kdո$$Ifl4*+04 laf4$If^kd$$Ifl4*+04 laf48:*R $$Ifa$\kd[$$Ifl4*+04 laf4 h$If^h$IfRTj >@gaaaaaaaaa$IfkdS$$Ifl4:\ D*,,X`X04 laf4 ,.0:<fh|~(*RThjlvxշըܞܑrjh$}5CJUjh$}CJUmHnHujh$}CJUjh$}CJUjh$}5CJUjh$}5CJUjzh$}5CJU h$}5CJ h$}CJjh$}5CJU!jh$}5CJUmHnHu(@BfTNNNN$Ifkd$$Ifl4r D*,,,, X04 laf4,Rz$Ifokd$$Ifl40*04 laf4z|~&N$Ifokd$$Ifl40*`04 laf4&(<>@JL tv*,.8:<>R͸ͩǥ͖͇xjh$}5CJUjAh$}5CJUjh$}5CJUh$}jh$}5CJUjh$}5CJU h$}CJ h$}5CJ!jh$}5CJUmHnHujh$}5CJUjh$}5CJU.NPzq $$Ifa$kd$$Ifl4 F*   0    4 laf4 =;2 $$Ifa$^kd;$$Ifl4$ *+04 laf4$If\kd=$$Ifl4*+04 laf4@tXkdQ$$Ifl4    p\O *Ov ` 0    4 lalf4$If $$Ifa$ <dTKKKKK $$Ifa$kdS$$Ifl4    prO *O 0    4 lalf4RTV`bdfz|~(*XZnpr|~ǸδǥǖLJδ}xk}jDh$}5U h$}5jh$}5Ujh$}5CJUjh$}5CJUjh$}5CJUh$}jh$}5CJU h$}5CJ h$}CJ!jh$}5CJUmHnHujh$}5CJUj-h$}5CJU',TNHHH$If$Ifkd$$Ifl4    prO *O 0    4 lalf4,.X$If$Ifqkd$$Ifl4    p0* 0    4 lalf402FHJTV xz .ɺЩɚЩɋЩ|ЩmЩjh$}5CJUjh$}5CJUj h$}5CJUjh$}5CJU!jh$}5CJUmHnHujh$}5CJU h$}5CJjh$}5CJU h$}CJh$}jh$}5Ujh$}5UmHnHu*XZ$Ifqkd$$Ifl4    p0*` 0    4 lalf4zq $$Ifa$kd$$Ifl4    rF!* v 0        4 lalf4 ;22 $$Ifa$^kd$$Ifl4    0**0    4 lalf4$If^kdj$$Ifl4    **0    4 lalf4DxXkd$$Ifl4    p\O *O  v  `  0    4 lalf4$If $$Ifa$ @hTKKKKK $$Ifa$kd$$Ifl4    prO *O 0    4 lalf4.02<>@BVXZdfhj~  ",.\^rtvǸǩΥǖLJxΥnjh$}5Uj1h$}5CJUjh$}5CJUj^h$}5CJUh$}jh$}5CJUjh$}5CJU h$}5CJ h$}CJ!jh$}5CJUmHnHujh$}5CJUjh$}5CJU+0TNHHH$If$Ifkdp$$Ifl4    prO *O 0    4 lalf402\$If$Ifqkdf$$Ifl4    p0* 0    4 lalf446JLNXZ |~ ʾʾʾyʾjʾjoh$}5CJUj`h$}5CJUjsh$}5CJU!jh$}5CJUmHnHujh$}5CJU h$}5CJjh$}5CJU h$}CJh$}jh$}5UmHnHujh$}5Ujh$}5U h$}5&\^$Ifqkd$$Ifl4    p0*` 0    4 lalf4zq $$Ifa$kd$$Ifl4    F!* v 0        4 lalf4";22 $$Ifa$^kd$$Ifl4    **0    4 lalf4$If^kd$$Ifl4    **0    4 lalf4"H|Xkd$$Ifl4    p\O *O  v  `  0    4 lalf4$If $$Ifa$ DlTKKKKK $$Ifa$kd$$Ifl4    prO *O 0    4 lalf4 246@BDFZ\^hjln  ",.\^r;͚ͩ͋|j9h$}5CJUjh$}5CJUjQh$}5CJUjh$}5CJU h$}CJjeh$}5CJU h$}5CJ!jh$}5CJUmHnHujh$}5CJUjh$}5CJU*0TNNNN$Ifkd$$Ifl4    prO *O 0    4 lalf402\$If$Ifqkd$$Ifl4    p0* 0    4 lalf4rtv24HJLVXZ |mjh$}5CJUjh$}5CJU h$}5CJjFh$}5Ujh$}5UmHnHujh$}5U h$}5jh$}5Uh$} h$}CJ!jh$}5CJUmHnHujh$}5CJUjh$}5CJU*Z\$If$Ifqkdv$$Ifl4    p0*` 0    4 lalf4zq $$Ifa$kd@$$Ifl4    pF!* v 0        4 lalf4;66$a$^kd!$$Ifl4    **0    4 lalf4$If^kd$$Ifl4    **0    4 lalf4 "8:<>F.02<>@BVXZ͉ͬ|ojh$}5Uj6h$}5U h$}6CJjh$}5UmHnHujh$}5U h$}5CJjh$}5Uj6h$}5U h$}CJj.h$}5Uh$} h$}5jh$}5Ujh$}5U+(*>8[kd$$Iflr*+04 la$If[kd$$Iflr*+04 la $$Ifa$ $$Ifa$[kd$$Ifl*+04 la$If & F$If@h}www$Ifkd$$IflrF D*XXX0    4 laZdfhj~ "$&0246JLNXZ\^rtvݶݩݜݏ݂jh$}5Ujh$}5Ujh$}5Ujh$}5Ujh$}5Uj(h$}5Uj"h$}5U h$}5h$}jh$}5Ujh$}5UmHnHu3 }www$Ifkd$$IflF D*XXX0    4 la 4\}www$Ifkd$$IflF D*XXX0    4 laNr}sii h$If^h & F$Ifkd|$$IflF D*XXX0    4 lartV^`|~FH\^`jln  <>@BXD}jh$}5Uj|h$}5Ujh$}5Ujh$}5Ujh$}5Uj"h$}5Ujh$}5UmHnHuj h$}5U h$}5jh$}5U h$}CJh$}1Fnp;^kd$$Ifl4*+04 laf4$If^kd$$Ifl4|*+04 laf4pBDF@B h$If^h^kd$$Ifl4r*+04 laf4$IfBDFHJ(qkd$$Ifl40*04 laf4$If^kd|$$Ifl4*+04 laf4JVakdt$$Ifl4\P* L04 laf4$If h3 h$}CJh30JmHnHu h$}0Jjh$}0JUh$} h$}CJ h$}5jh$}5Ugaa$Ifkd$$Ifl4D\P* L04 laf4xri$h]ha$h]h&`#$$h]ha$h]h&`#$$a$^kd$$Ifl4r*+04 laf4 $a$/ =!"#h$h%5(Dd% ]dN  c *AUNb'R:X!DRαȹo'Dng'R:X!DRαȹPNG  IHDRgAMA0PLTE{ IDATxYE%3Eݓ`5[m~*j喼!Yv]>|8(ApP>|8(ApP^pK7 {1÷xO֧)zL78T,|,|9GǗfݼ^z.}#h #m&43/_)/v{zj?}j| -Ȏt%7xm]%&-`˞B[Vrsr@?-w0RWC 8`R~KNq6b  rp2 JpspX,j9+>\RiEPպUN ^&vwUM! ]Jp تYzٲSPu7Q& PWְ_>$x3=`VkJp;^ Ϥ`@=,6d4 D)*2 Ħw&Q^) 0~ &]bF1?0ɫ q f\y*mhb4ԥG.:8;M‡> ??ݼqH4'!h`R4]?~Ԫob=}ɜs_16<gĽi` +uQmCq]ęv:ai9DŽ/37ֶkb%ݞsSܑ qb4498IS鉶߽=$qyK | &:DK TD`eR̶H!V+~ʜU9Qb);4 HS/$= $g.(މt'B-3(R> i!E@6J[R&h0~ۯ$* ec5e:-J`}l7U4A{aQ7&= Ppu[Ԧޜn\P0ۂ4Z6̉[NJ' x35%ؽR ?-|m S+-?09=P(܍LT tDV c6"Mg:4##(|+ڙ7g=T +Hg+Q⢺?%mmQpMz+zbQ;zyb#!%1\:ܳ}@~tBb]~ZO@o'[BdE[о37ls|HF727䇶*@v `5pJ3&H-Y>U& ~Ƙ֭< ? -WșG  _PĩG*=~;MY7a-Ԟ[EBGIRn7YRp 6~qY=cHDscw?0GK`0-cxU&2r{J8ԝUu@|%"YQpӔ\#| ;DrzCHm yvz # J=j'i;3$y837t"Q!cM?0Gk J ŔKP|/p7@ @P^z9}~{V >Wc+)Ƚ{ @ 4 `%6Y?u~G:iQ(33 l4AP:oH%lTiނF6锝D,@yCfMlp8' H'| &<51z+o " <!SI<p0Z \: [+b'E|wYf*)x#}"LC0do!4$D" OJ?GK ?Q"_F-"0w*KI`o-}" ֗2?}wZ^i{@t2ـ SvȞ7*AVFJa@2K@jA8HۧETgiC>:R柳1cazHw^s;@n@b??=w2xSc‡_+`J^iG0G %rI![pَ@4R|ө 9{J[{{I%|%Ol$/2j9&UsDIJ p֌5$9:_abg(j¡h~3EXKdv 6]x,whO;.;3ߍ\cjAs:cX\pP5Y4%5,UM8v2)ME7P 0 S+RC[aI= 0#^ضS\q 1u3/E h/e* g\Y? a P"cl*C֕^@h+ܘ$2u~_6k)"egga\) 03Ul 9W1\::6^}8O |(i9#8 0*֠Թn,¢ :foT( t Vp #{!Vr'cbAcqNn Ղ)x@Aa֦s_&Z0$@q4sS5. GCVM;TpmԪ͈kE>0]e5l I'MiE{ւA)HAt!op_vo"CK"`-@M hHjHJ]b Iv@2\Dp`e|(`Y/ S Poh@Jt|@tߛØ <pnɮrsWLR%={9#0r`Ç _בS t;e9c/$@ҽ1CH tq BeԸ2 ,adUe  %,4!SQ WHR6AlZ,,=$"LJ!%-9C-8vh7H6 AK,GNPlezYHTۻy݂ HLkyEXh.Nzua+J(R"@(|+@fQ}cb2rVhZ_nУ"s6a2}=pF%d@{TDxC F Q9@Z pq=H7@[,lEo oL7~c$ L pQ-UHJ :qbdn@wl.d50"*WM(P<`g%ME 7C6p> psxX cԽG"7:n_ j~摒ѳʕ'erN<R~f!Ӭ=?'aJQ7D*F2 19f B— 7 I1̅9Z"tX:@LG9^bax$<:@gEv'7j - ؁'= hb-`\fmfe0 =۵B,;M:E=xSu#rc bҹ ۄ{<2\C4 /OX(lʡ(G7j_C3@s arjJ=Żͺ ΅FF^#ьk` cBJn N|t K1)\="{0%@5ƆUэP X@:0VvtER pQDw6FE~= 1|x|֙5.XG&2"1%.%g.^G;qYս\rZN 4@r7F@.;ră@ƉyW>%,\C9qM<}$85. nW4 4@.kNܹ bqTg9AwV N+i$S9tKE0jm +ȗ@2W= Za^HtŁ d cC%`@&Ubpp3^P\YyEXu:YlBO+LȀP}ww1zauȗmp̢0@sS#r3l;(0-%LO.؎8rM IJ/*u4 pUʧh"F7I j9`nM9:Шѝց9^(Nm X=BڎK> n%! ʘ*8(ңV,-k܂"wLU|LKy 5+rlczS xf| @zZ)?Co }o=tz(z;\,' ϵGn(Uii)x)PD.GuWaYSMA6;K׹)Ɏ`q]i]g[I@tuTۂUJJ1sMc}&72]'1azeK#APtJ$_U=K7~/H2 s@5)`+C`Z#ȝyH[a jSkG&=|I4/ۊJ 1S#[Y;ΖpLp_ t+\:q9!@sf.\wPe_ B5Pi$&ag@T< `I@8h&y$y Rý e@p,kroWD J\$F$&z݇[ 8vRKpV;y\5ZBN@< >HEm `MSO/6(heik0J:LdcKEA ̱QѭhqCwMd% `Sd%V0H:?ʂnI gw\$@k,`=W-^Yj U[[4>`K#Xh PW̍4&ӕ섀{S2 Rp43M˅u| e ؼ7'Vnٚ&# $mxTq w#1D9ւ/FI=;ibJ@1ȄF;'cXHpx# `bpe'9spIh E͟?$@K*9 8>iFf_i'81ؾ}N{aYY]AwFA3S$  D9@o+Jw%pO4@ ~mg`ᨁ[y<>" @Gs к3{G c; m Shjpk۹ER#MϚГHW"*:]GkU(+D9Le1P~gj6(JюEL D0ݦz')x{\&fe5ut*?)O'. h\;O/"%2$ǙJj; DA)^Dbi9%f)d&(Q|n`tW KRHLcky;~)@5il@gG_}+K@>8VQRfR?T"|r 8r#PW,@AB}П]MVSޚϵWyG90MbVjRF.?2MyiOKU؜E/,ǹ%\ħ7c72)l=bdeB " M4@p}*"PpVjo"/'r7LoмMK@:8i|' l 2g|ٖ'. l9p9 `p7wDovT3lEb 0Ҕ|S*޺?w8>b~H'@=,ǭz"C!NAw8pUS " PJO7 U|z PhXnL`trb >\ڕjc Rh`n *>y~4!ZR.~KR_i رM.mk,?"lMRi{Mܐ}dv1dZǮPI>`N[F*6< wtur(#EX"(r2֐\wF&.eN@,4 &ե\ ߜ Z{3UT(bC++;$#5h j7mNi&`7X H^"O-05U:W9,(`u:ņh*|.)hd5# 0-7P LTKpk XRw]=]M x?aP;־ģXv%:@gB>!U%IDAT|Yt9Q6@hP&X(i+F,=m,,<"@٧.M6wG*?x!_.4#TWF|Mxҧ_n0yBׅN/=h. \ }MfWM83hdTHK<TAdٛ !NoaN{`r##&@9 U1k0l?h;/g*"ʤpe EN^)`#} zG~ mzoc aJ_Oǎr'/p0bF*I& 4%Y*^ nZ{, .HٖP` ;:y`ym0ho'>.40K f'4}ڬ/eBU"^]+1!eFw*VmV(?ĴHx2 폣R׀CՓ>Ɲ|nZB<~Adƕ~T~yG\uHz>adݪ*P0}ID)+w*KI%sd!XBVD&L|vo ՟8S?ӏ# V SX_eZ~œYC4;<Иu'T'@S, V[Jx)=#_٦.cwO0r*V;I$(_Oq[;I2y~@>g vdO#ѽ 7e^;DG[RP=ny;r3-+H gM~ f LkHg-v>|A f]„Ny`%`, F_cd3LIh̉*ErIa\5>o@7 __DUg꺵$~]\_͍LWڋ^WPkI~ߍ,f<>!>Z~+t#M3(ºB}=l[֋~D m둋pVri$vS ŇgR7/& o V޲2φ-toҷE*g)}Js% +ow5=͝ӺU /R?vOrK%[@[Q(}-8Ud~m\r9|d5yI 36'ǧwHNOwJ_WAat .?EjƊR%r!1`!hu+sוOYYu~îgwHL2 ثvȳ.Q xoZώfVu0JP[A)O~nDy`m|k >R)ߛH)Ghp27I|8(ApP>|8(ApP>|8(ApP>|8(p.#4IENDB`$$If!vh555#v#v#v:V l0555/ /  / 4aDText69 UppercaseDText2 First capitalDText3 First capitalDText4 First capital$$If!vh5 5 5 5 #v #v #v #v :V l4 05 5 5 5 / / / / 4af4DText5 dd/MM/yyyyDText6 First capitalDText7 First capitalDText8 First capitalD Text9 First capital$$If!vh55555#v#v#v#v#v:V l4p055555/ / 4af4vD Text10vD Text11tDeCheck1tDeCheck2tDeCheck3tDeCheck4tDeCheck5$$If!vh555_!#v#v#v_!:V l4p0555]!/ / / / 4af4tDeCheck1tDeCheck1tDeCheck1tDeCheck1$$If!vh5*#v*:V l405*/  4af4vDText12vDText59vD Text58vDText15vD Text62vD Text17vDText18vD Text19$$If!vh5j55 #vj#v#v :V l40++5j55 / / 4af4jD jD vDText80$$If!vh5j55 #vj#v#v :V l40++5j55 / / 4af4tDeCheck1tDeCheck1$$If!vh5*#v*:V l40,5*/  4af4$$If!vh5 5p555 #v #vp#v#v#v :V l40,5 5p555/ / / / 4af4D First capitalDText82 dd/MM/yyyyD First capitalD First capitaljD$$If!vh5 5p555 #v #vp#v#v#v :V l405 5p555/ / / / 4af4D First capitalDText82 dd/MM/yyyyD First capitalD First capitalvDText81$$If!vh5 5p555 #v #vp#v#v#v :V l405 5p555/ / / / 4af4D First capitalDText82 dd/MM/yyyyD First capitalD First capitaljD$$If!vh5 5p555 #v #vp#v#v#v :V l405 5p555/ / / / 4af4D First capitalDText82 dd/MM/yyyyD First capitalD First capitaljD$$If!vh5 5p555 #v #vp#v#v#v :V l405 5p555/ / / / 4af4D First capitalDText82 dd/MM/yyyyD First capitalD First capitaljD$$If!vh5 5p555 #v #vp#v#v#v :V l405 5p555/ / / / 4af4D First capitalDText82 dd/MM/yyyyD First capitalD First capitaljD$$If!vh5 5p555 #v #vp#v#v#v :V l405 5p555/ / / / 4af4D First capitalDText82 dd/MM/yyyyD First capitalD First capitaljD;$$If!vh5 5p555 #v #vp#v#v#v :V l4O0,5 5p555/ / /  / / / 4af4tDeCheck1tDeCheck1vDText23$$If!vh5*#v*:V l405*/  4af4tDeCheck6tDeCheck1vDText60$$If!vh5*#v*:V l4?05*/  4af4tDeCheck1tDeCheck1$$If!vh5*#v*:V l4]05*/  4af4$$If!vh55Y5#v#vY#v:V l4055Y5/ / 4af4D2 First capitalD First capitalD First capital$$If!vh55Y5#v#vY#v:V l4055Y5/ / 4af4D2 First capitalD First capitalD First capital$$If!vh55Y5#v#vY#v:V l4055Y5/ / 4af4D2 First capitalD First capitalD First capital$$If!vh55Y5#v#vY#v:V l4055Y5/ / 4af4jD2$$If!vh5*#v*:V l4p05*/  4af4tDeCheck1tDeCheck1tDeCheck1tDeCheck1jD$$If!vh5:5#v:#v:V l4F05:5/  / / 4af4jD$$If!vh5*#v*:V l405*/  / 4af4$$If!vh555t5p5#v#v#vt#vp#v:V l40+,555r5p5/ / / 4af4|$$If!v h55K5M5D505h555 :#v#vK#vM#vD#v0#vh#v#v#v ::V l40+, 55K5L5D505h555 :/ / /  /  4af4kdl$$Ifl4 = I!I&* KLD0h:0$$$$4 laf4vDText43tDeCheck7tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1$$If!v h55K5M5D505h555 L5 #v#vK#vM#vD#v0#vh#v#v#v L#v :V l4055K5L5D505h555 L5 /  / / / /  / / / / /  / / / / /  / / / /  / / /  / / 4af4kd]t$$Ifl4 = I!"'*KLD0hL0((((4 laf4vDText65tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1$$If!v h55K5M5D505h555 L5 #v#vK#vM#vD#v0#vh#v#v#v L#v :V l4055K5L5D505h555 L5 / / / / / / / / / / / / / / / / /  / / / / / 4af4kd&}$$Ifl4 = I!"'*KLD0hL0((((4 laf4vDText66tDeCheck1tDeCheck8tDeCheck1tDeCheck9tDeCheck1vDeCheck10vDeCheck11vDeCheck12$$If!v h55K5M5D505h555 L5 #v#vK#vM#vD#v0#vh#v#v#v L#v :V l4055K5L5D505h555 L5 / / / / / / / / / / / / / / / / /  / / / / / 4af4kdم$$Ifl4 = I!"'*KLD0hL0((((4 laf4vDText67tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1$$If!v h55K5M5D505h555 L5 #v#vK#vM#vD#v0#vh#v#v#v L#v :V l4055K5L5D505h555 L5 / / / / / / / / / / / / / / / / /  / / / / / 4af4kd$$Ifl4 = I!"'*KLD0hL0((((4 laf4vDdText25$$If!vh55:#v#v::V l4p0+55:/  / 4af4$$If!vh5555w 5:#v#v#v#vw #v::V l40++++,5555u 5:/ / 4af4vD Text68vD Text68{$$If!vh5555G505:#v#v#v#vG#v0#v::V l40++++5555F5/5:/ / /  / / / / / 4af4vDText24vDText24vDText24vDText24B$$If!vh5555G505:#v#v#v#vG#v0#v::V l4X0+5555F5/5:/ /  / / / 4af4vDText24vDText24vDText24vDText24P$$If!vh5555G505:#v#v#v#vG#v0#v::V l4=0+5555F5/5:/ /  / / /  / 4af4$$If!vh5+#v+:V l405+4f4$$If!vh5 55* 5 #v #v#v* #v :V l40+++,5 55* 5 4f4$$If!vh5 555* 5 #v #v#v#v* #v :V l40+++5 555* 5 4f4DText73 First capitalDText45MMM-yyDText46MMM-yyDText28 First capitalDText29 First capital$$If!vh5 555* 5 #v #v#v#v* #v :V l4l0,5 555* 5 4f4DText73 First capitalDText45MMM-yyDText46MMM-yyDText28 First capitalDText29 First capital$$If!vh5 555* 5 #v #v#v#v* #v :V l4l0,5 555* 5 4f4DText73 First capitalDText45MMM-yyDText46MMM-yyDText28 First capitalDText29 First capital$$If!vh5 555* 5 #v #v#v#v* #v :V l4l0,5 555* 5 4f4$$If!vh5+#v+:V l4 0,5+4f4$$If!vh5 55* 5 #v #v#v* #v :V l40+++,5 55* 5 4f4$$If!vh5 55505 #v #v#v#v0#v :V l40+++5 55505 4f4vDText26vDText26DText53MMM-yyDText52MMM-yyvDText54$$If!vh5 55505 #v #v#v#v0#v :V l4Q0,5 55505 4f4vDText26vDText26DText53MMM-yyDText55MMM-yyvDText26$$If!vh5 55505 #v #v#v#v0#v :V l4l0,5 55505 4f4vDText26vDText26vDMMM-yyDText51MMM-yyvDText26$$If!vh5 55505 #v #v#v#v0#v :V l40,5 55505 4f4vD,Text63$$If!vh5+#v+:V l405+4f4D,Text64 First capital$$If!vh5+#v+:V l405+4f4$$If!vh5+#v+:V l405+4f4vDText42$$If!vh5,5,5X5X#v,#vX:V l4:0+,5,5X4f4DText34MMM-yyD First capitaljDvDText26$$If!vh5,5,5,5,5X#v,#vX:V l40+5,5X4f4vDText26vDText26$$If!vh55#v:V l4054f4vDText72jD-$$If!vh55#v:V l40+54f4vDText35D#Text36 First capital$$If!vh55 5 #v#v :V l4 0+55 4f4$$If!vh5+#v+:V l40,5+4f4vDText56$$If!vh5+#v+:V l4$ 05+4f4DText42 First capital$$Ifl!vh5O55v 5 #vO#v#vv #v :V l4p0    +,5O55v 5 / /  / 4alf4$$Ifl!vh5O5555 #vO#v#v :V l4p0    +,5O55 / / 4alf4vDMMM-yyvDMMM-yyvDText42vDText42$$Ifl!vh5O5555 #vO#v#v :V l4p0    +,5O55 / / 4alf4D First capitalD First capital$$Ifl!vh55 #v#v :V l4p0    55 /  / / 4alf4jDD First capital$$Ifl!vh55 #v#v :V l4p0    +55 /  / / 4alf4D First capitalvDText74$$Ifl!vh55v 5#v#vv #v:V l4r0    +55v 5/ / 4alf4$$Ifl!vh5*#v*:V l40    ,5*/  4alf4vDText76$$Ifl!vh5*#v*:V l400    5*/  4alf4DText42 First capital$$Ifl!vh5O55v 5 #vO#v#vv #v :V l4p0    +,5O55v 5 / /  / 4alf4$$Ifl!vh5O5555 #vO#v#v :V l4p0    +,5O55 / / 4alf4vDMMM-yyvDMMM-yyvDText42vDText42$$Ifl!vh5O5555 #vO#v#v :V l4p0    +,5O55 / / 4alf4D First capitalD First capital$$Ifl!vh55 #v#v :V l4p0    55 /  / / 4alf4jDD First capital$$Ifl!vh55 #v#v :V l4p0    +55 /  / / 4alf4D First capitalvDText74$$Ifl!vh55v 5#v#vv #v:V l40    +55v 5/ / 4alf4$$Ifl!vh5*#v*:V l40    ,5*/  4alf4vDText49$$Ifl!vh5*#v*:V l40    5*/  4alf4DText42 First capital$$Ifl!vh5O55v 5 #vO#v#vv #v :V l4p0    +,5O55v 5 / /  / 4alf4$$Ifl!vh5O5555 #vO#v#v :V l4p0    +,5O55 / / 4alf4vDMMM-yyvDMMM-yyvDText42vDText42$$Ifl!vh5O5555 #vO#v#v :V l4p0    +,5O55 / / 4alf4D First capitalD First capital$$Ifl!vh55 #v#v :V l4p0    55 /  / / 4alf4jDD First capital$$Ifl!vh55 #v#v :V l4p0    +55 /  / / 4alf4vDText75D First capital$$Ifl!vh55v 5#v#vv #v:V l4p0    +55v 5/ / 4alf4$$Ifl!vh5*#v*:V l40    ,5*/  4alf4jD$$Ifl!vh5*#v*:V l40    5*/ 4alf4tDeCheck1tDeCheck1$$If!vh5+#v+:V lr0,5+/ 4tDeCheck1tDeCheck1vDText37$$If!vh5+#v+:V lr0,5+4$$If!vh5+#v+:V l0,5+4$$If!vh5X5X5X#vX:V lr0,5X4vDText37vDText37vDText37$$If!vh5X5X5X#vX:V l05X4vDText37vDText37vDText37$$If!vh5X5X5X#vX:V l05X4vDText37vDText37vDText37$$If!vh5X5X5X#vX:V l05X4DText77 First capital$$If!vh5+#v+:V l4|05+4f4hDehDeDText39 First capital$$If!vh5+#v+:V l405+4f4tDeCheck1tDeCheck1$$If!vh5+#v+:V l4r0,5+4f4$$If!vh5+#v+:V l40,5+/ 4f4$$If!vh55#v:V l40,5/ / / / / / 4f4vDText79<$$If!vh5 555L#v #v#v#vL:V l40,5 555L/ / / / / / / / 4f4<$$If!vh5 555L#v #v#v#vL:V l4D0,5 555L/ / / / / / / / 4f4$$If!vh5+#v+:V l4r0,5+/ / 4f48@8 Normal_HmH sH tH <@< Heading 1$@&6CJ8@8 Heading 2$@&CJ@@ Heading 3$$@&a$5688 Heading 4$@&CJ>@> Heading 5$$@&a$5DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List 2B@2 Body TextCJ4@4 Header  !4 @4 Footer  !.)@!. Page Number4"4 Caption$a$CJ8PB8 Body Text 2$a$,h #7KLd3:NdJ8H\]78'(<Pdx.BVWk ! 5 I ] q   v H  # 7 8 L ` t u  !"27=CNOPWbit} 0BCWi{!3EWij|"45Nq#5GYklmwWX{|2FZn$8LM6789>ABCWk  !5I]qr)=>  &@TU`t-AThij058Keyz-ABWk127:Mg{|  / C D Y m !!!!3!4!9!ADGJKLNORTW\^ce} , `*R p!#T$$&% (++H,,$-- /&/0x1B2<34.445`8R@zN,0"0 pBJ !#%')*+-/13468:<=?@BCEFHIMPQSUVXYZ[]_`abdf|~!7CIlx~+1:FLk{ .8H $06HTZq}#/5o(4:<HNP\bdpvx&,.:@BNTWcikw}   ! - 3 5 A G I U [ ] i o q }  z I Y d t  + 6 F    ! # / 5 8 D J L X ^ ` l r    .0@COUWgiy{ !13CEUWgjz|  "2#/35AEGSWYeiw*02>DFRXZflnz"$068DJCOUWcikw}  !-35AGIU[]io)5;@LR`lr-9?T`feqw-9?Wci)/gsy   / ; A Y e k !!+!1!i!u!{!!!!!!!!!!!!! """/";"A"Y"e"k""""""""""#*#0#####$.$8$H$u$$$%%%%%%%%%%&&&&&&(&.&1&=&C&E&Q&W&Y&e&k&&&&'''(N(Z(`( )0):)J)***,FtFtFtFtFtFtFtFtFtFtFtG$G$G$G$G$G$G$G$G$FtFtFtFtFtFtFtFtFtFtFtG$G$FtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtG$G$FtG$G$FtG$G$FFtFtFtFtFtFtFtFtFtG$G$G$G$FtFtFtG$G$G$G$G$G$G$G$FtG$G$G$G$G$G$G$G$FtG$G$G$G$G$G$G$G$FtG$G$G$G$G$G$G$G$FtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFFFFtFtFFFtFtFtFFFtFtFtFFtFtFtFtFtFtFtFtFtFtFtFtFtFtFFFtFtFtFtFtFtFtFtFtFtFFFtFtFtFtFtFtFtFtFtFtFFFtFtFtFtFtFtFtG$G$G$G$FtFtFtFtFtFtFtFtFtFtFtG$G$FtG$G$Ft 5!!t!8@0( !!BBBeee B S  ?,GText69Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Check1Check2Check3Check4Check5Text12Text59Text58Text15Text62Text17Text18Text19Text80 Dropdown1Text82Text81Text23Check6Text60Text43Check7Text65Text66Check8Check9Check10Check11Check12Text67Text25Text68Text24Text73Text45Text46Text28Text29Text53Text52Text54Text55Text51Text63Text64Text34Text72Text35Text36Text56Text42Text74Text76Text49Text75Text37Text77Text39Text71Text798m ;l %Ir$(= J D4Xk}$3G[olJ*a.f !"v$&O(**,  !"#$%&'()*+,-./0123456789:;<=>?@ABCDFE"J2M|!7[6OP Z V Di{41EYm~\<s@x02!"$&a(**,&&&&\z&&T&& &&T& &!&"& #&$&%&V&&'&$nAC E!"##%%((,     qDF H!"##%%((, ?*urn:schemas-microsoft-com:office:smarttags stockticker ,,,,,,,,,QV &&,,,,,,,,,3333333#7Ld3:NTd 7H]o7@k(  v E v  u   "5N#mw#b|SWCr> &@U`t-ATjn 0Kez-BWk2Mg|  / D Y m !!4!O!i!~!!! ""/"D"Y"m"""""""##6#<###$l$$%%n&&&&''N(c(k(()W))***+,,,,,,,,,,,,,>l  1 Cn; n" {|* UP+nA/ %3 ?u88 [;]o= En>[ .`n9nn2vH&"hh^h`o(.hh^h`o(.hh^h`. ww^w`o(.hh^h`.hh^h`.hh^h`o(.hh^h`.hh^h`o(.hh^h`5o(. >^`>o(.hh^h`o(.hh^h`.hh^h`o(.hh^h`o(.hh^h`.^`o(.A/n"[;; >[2vo=%3>l 1?u88{|*9nCEUP+.`>$s3$}3#KL3N878'(<Pdx.BVWk ! 5 I ] q    # 7 8 L ` t u !"27=CNOPWbit} 0BCWi{!3EWij|"45q#5GYklmw{|2FZn$8LM6789>ABCWk  !5I]qr=>  &TUtAhij058KyzABk127:M{| C D m !!!!3!4!9!$ INSTRUCTIONSVERONICA GARCIARegional RepresentativeP            Oh+'0   < H T `lt|INSTRUCTIONSVERONICA GARCIA Normal.dotRegional Representative2Microsoft Word 10.0@F#@$@:BM@:BM%՜.+,0 hp  United NationsPk,  INSTRUCTIONS Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./012356789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwyz{|}~Root Entry FpU5"MData 1Table4/WordDocumenthSummaryInformation(xDocumentSummaryInformation8CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q