ID Card Request Form

ID Card Request Form
Request for a duplicate of ID card for entry into the L. Pasteur University Hospital

* required data

Name * Surname *
PIK number * (17-digit of ISIC card)
Year of study * (selection 1,2,3,4,5,6)
Study program * (selection GM, DM)
Confirmation

Please check all the information you provided in the form.
I hereby certify that all information in this form is true.
I agree with the processing of personal data in accordance with § 5 letter a) and in accordance with § 14 of Act no. 18/2018 Collections of Acts on Personal Data Protection and on Amendments to Certain Acts.