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Emergency Preparedness: Personal Documentation Log

DO NOT enter credit card, social insurance, MSI or passport information online on this page, as this is NOT a secure site. You can either fill in the public information (e.g., contact, doctor, family lawyer) before printing, or print off a blank copy of the log and fill it in by hand. Keep in an easy-to-reach safe area, preferably in your household and car survival kits.

 

General Household Information

 

 

Out-of-area contact

 

Name:

Phone:

Family Doctor

 

Name:

Phone:

Family Lawyer

 

Name:

Phone:

Insurance

 

Company:

Policy Number:

Phone:

Credit Cards

 

1. Institution:

Card Number:

Expiry Date:

Customer Service Phone Number:

2. Institution:

Card Number:

Expiry Date:

Customer Service Phone Number:

3. Institution:

Card Number:

Expiry Date:

Customer Service Phone Number:

Household Occupants

 

1. Name:

Special Medical Needs (if any):

S.I.N. Number:

MSI Number:

2. Name:

Special Medical Needs (if any):

S.I.N. Number:

MSI Number:

3. Name:

Special Medical Needs (if any):

S.I.N. Number:

MSI Number:

4. Name:

Special Medical Needs (if any):

S.I.N. Number:

MSI Number:

5. Name:

Special Medical Needs (if any):

S.I.N. Number:

MSI Number:


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