| Family Name (*) |
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| First Name (*) |
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| Sex (*) |
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| Marital status (*) |
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| Date of birth (*) |
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Month
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Year
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| Nationality (*) |
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| Second Nationality |
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| Place of birth (*) |
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| Home Address (*) |
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| Home Zip Code and City (*) |
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| Tel. No. Home (*) |
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| Fax. No. Home |
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| Address during terms (in CH) (*) |
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| Zip Code, City during terms (in CH) (*) |
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| Tel. No. during terms (in CH) (*) |
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| Fax. No. during terms (in CH) |
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| Handy (only for internal use) |
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| Private E-mail preferred (ex. muster@hotmail.ch) (*) |
Is your email correct?! |
| 2nd E-mail (If you have another email, please specify. ex. muster@uni.net) |
Is your email correct?! |
| Passport No. (*) |
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| Passport issued at (*) |
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| Passport valid until (*) |
| Day
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Month
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Year
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| Are you medically fit? (*) |
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