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ICE (Emergency Information)

Genis Pieterse
Tanya Pieterse

Gender:

 

Age:

 

Date of Birth:

 

Nationality:

 

Country of Residence:

 

Medical Insurance:

 

 

Emergency Contact:

 

 

 

Medical Allergies:

 

 

Family Physician

Male

49

14 December 1968

South African

South Africa

Columbus Direct

41234935/0002/CTI

Arielle Pieterse (Daughter)

+27 (0) 82 565-9590

Maxolon (Metoclopramide Hcl)

Clive Landman

+27 (0) 12 661-5528

Female

48

12 March 1969

South African

South Africa

Columbus Direct

41234935/0002/CTI

Arielle Pieterse (Daughter)

+27 (0) 82 565-9590

None

Clive Landman

+27 (0) 12 661-5528

TIC: 15823C

Santam Limited

+27 11 991 8409

Gender:

 

Age:

 

Date of Birth:

 

Nationality:

 

Country of Residence:

 

Medical Insurance:

 

 

Emergency Contact:

 

 

 

Medical Allergies:

Family Physician

Alternative Insurance