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<html> |
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<head> |
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<title>Certificate request</title> |
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<link rel="stylesheet" type="text/css" href="stylesheet.css"/> |
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</head> |
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<body class="ui"> |
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<h1>Certificate request - Personal Details</h1> |
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|
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<p>Before you get access to the grid computing facilities, we need some |
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personal information and proof that you are who you claim to be. We are |
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verify careful with your personal details, please read the |
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<a href="http://ca.dutchgrid.nl/privacy.html">privacy policy</a> for |
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additional information.</p> |
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<p></p> |
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|
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<form><table> |
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<tr> |
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<th><u>F</u>amily name</th> |
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<td><input type="text" size="15" name="surname" accesskey="F"/></td> |
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</tr> |
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<tr> |
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<th>Given name(s)</th> |
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<td><input type="text" size="25" name="givenname"/></td> |
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</tr> |
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<tr> |
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<th>Place of birth</th> |
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<td><input type="text" size="15" name="birthplace"/></td> |
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</tr> |
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<tr> |
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<th>Date of birth</th> |
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<td><input type="text" size="10" name="birthdate"/></td> |
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</tr> |
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<tr> |
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<th>Personal phone</th> |
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<td><input type="text" size="10" name="homephone"/></td> |
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</tr> |
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<tr> |
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<th colspan="2"><b>Proof of identity: passport or driver's license</b></th> |
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</tr> |
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<tr> |
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<th>type & number</th> |
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<td><input type="text" size="25" name="identity"/></td> |
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</tr> |
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<tr> |
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<th>issuing country</th> |
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<td><select name="country"> |
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<option value="AF">Afghanistan</option> |
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<option value="AX">Åland Islands</option> |
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<option value="AL">Albania</option> |
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<option value="DZ">Algeria</option> |
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<option value="AS">American Samoa</option> |
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<option value="AD">Andorra</option> |
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<option value="AO">Angola</option> |
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<option value="AI">Anguilla</option> |
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<option value="AQ">Antarctica</option> |
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<option value="AG">Antigua and Barbuda</option> |
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<option value="AR">Argentina</option> |
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|
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<option value="AM">Armenia</option> |
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<option value="AW">Aruba</option> |
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<option value="AU">Australia</option> |
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<option value="AT">Austria</option> |
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<option value="AZ">Azerbaijan</option> |
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<option value="BS">Bahamas</option> |
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<option value="BH">Bahrain</option> |
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<option value="BD">Bangladesh</option> |
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<option value="BB">Barbados</option> |
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<option value="BY">Belarus</option> |
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<option value="BE">Belgium</option> |
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<option value="BZ">Belize</option> |
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<option value="BJ">Benin</option> |
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<option value="BM">Bermuda</option> |
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<option value="BT">Bhutan</option> |
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<option value="BO">Bolivia</option> |
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<option value="BA">Bosnia and Herzegovina</option> |
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<option value="BW">Botswana</option> |
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<option value="BV">Bouvet Island</option> |
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<option value="BR">Brazil</option> |
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<option value="IO">British Indian Ocean Territory</option> |
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<option value="BN">Brunei Darussalam</option> |
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<option value="BG">Bulgaria</option> |
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<option value="BF">Burkina Faso</option> |
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<option value="BI">Burundi</option> |
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<option value="KH">Cambodia</option> |
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<option value="CM">Cameroon</option> |
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|
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<option value="CA">Canada</option> |
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<option value="CV">Cape Verde</option> |
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<option value="KY">Cayman Islands</option> |
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<option value="CF">Central African Republic</option> |
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<option value="TD">Chad</option> |
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<option value="CL">Chile</option> |
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<option value="CN">China</option> |
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<option value="CX">Christmas Island</option> |
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<option value="CC">Cocos (keeling) Islands</option> |
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<option value="CO">Colombia</option> |
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<option value="KM">Comoros</option> |
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<option value="CG">Congo</option> |
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<option value="CD">Congo, the Democratic Republic of the</option> |
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<option value="CK">Cook Islands</option> |
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<option value="CR">Costa Rica</option> |
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<option value="CI">Cote d'Ivoire</option> |
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<option value="HR">Croatia</option> |
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<option value="CU">Cuba</option> |
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<option value="CY">Cyprus</option> |
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<option value="CZ">Czech Republic</option> |
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<option value="DK">Denmark</option> |
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<option value="DJ">Djibouti</option> |
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<option value="DM">Dominica</option> |
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<option value="DO">Dominican Republic</option> |
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<option value="EC">Ecuador</option> |
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<option value="EG">Egypt</option> |
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<option value="SV">El Salvador</option> |
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<option value="GQ">Equatorial Guinea</option> |
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<option value="ER">Eritrea</option> |
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<option value="EE">Estonia</option> |
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<option value="ET">Ethiopia</option> |
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<option value="FK">Falkland Islands (Malvinas)</option> |
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<option value="FO">Faroe Islands</option> |
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<option value="FJ">Fiji</option> |
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<option value="FI">Finland</option> |
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<option value="FR">France</option> |
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<option value="GF">French Guiana</option> |
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<option value="PF">French Polynesia</option> |
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<option value="TF">French Southern Territories</option> |
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<option value="GA">Gabon</option> |
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<option value="GM">Gambia</option> |
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<option value="GE">Georgia</option> |
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<option value="DE">Germany</option> |
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<option value="GH">Ghana</option> |
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<option value="GI">Gibraltar</option> |
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<option value="GR">Greece</option> |
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<option value="GL">Greenland</option> |
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<option value="GD">Grenada</option> |
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<option value="GP">Guadeloupe</option> |
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<option value="GU">Guam</option> |
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<option value="GT">Guatemala</option> |
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<option value="GG">Guernsey</option> |
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<option value="GN">Guinea</option> |
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<option value="GW">Guinea-bissau</option> |
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<option value="GY">Guyana</option> |
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<option value="HT">Haiti</option> |
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<option value="HM">Heard Island and McDonald Islands</option> |
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<option value="VA">Holy Vee (Vatican City State)</option> |
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<option value="HN">Honduras</option> |
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<option value="HK">Hong kong</option> |
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<option value="HU">Hungary</option> |
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<option value="IS">Iceland</option> |
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<option value="IN">India</option> |
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<option value="ID">Indonesia</option> |
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<option value="IR">Iran, Islamic Republic of</option> |
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<option value="IQ">Iraq</option> |
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<option value="IE">Ireland</option> |
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<option value="IM">Isle of man</option> |
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<option value="IL">Israel</option> |
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<option value="IT">Italy</option> |
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<option value="JM">Jamaica</option> |
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<option value="JP">Japan</option> |
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<option value="JE">Jersey</option> |
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<option value="JO">Jordan</option> |
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<option value="KZ">Kazakhstan</option> |
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<option value="KE">Kenya</option> |
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<option value="KI">Kiribati</option> |
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<option value="KP">Korea, Democratic People's Republic of</option> |
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<option value="KR">Korea, Republic of</option> |
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<option value="KW">Kuwait</option> |
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<option value="KG">Kyrgyzstan</option> |
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<option value="LA">Lao People's Remocratic Republic</option> |
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<option value="LV">Latvia</option> |
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<option value="LB">Lebanon</option> |
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<option value="LS">Lesotho</option> |
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<option value="LR">Liberia</option> |
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<option value="LY">Libyan Arab Jamahiriya</option> |
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<option value="LI">Liechtenstein</option> |
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<option value="LT">Lithuania</option> |
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<option value="LU">Luxembourg</option> |
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<option value="MO">Macao</option> |
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<option value="MK">Macedonia, the former Yugoslav Republic of</option> |
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<option value="MG">Madagascar</option> |
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<option value="MW">Malawi</option> |
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<option value="MY">Malaysia</option> |
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<option value="MV">Maldives</option> |
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<option value="ML">Mali</option> |
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<option value="MT">Malta</option> |
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<option value="MH">Marshall Islands</option> |
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<option value="MQ">Martinique</option> |
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<option value="MR">Mauritania</option> |
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<option value="MU">Mauritius</option> |
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<option value="YT">Mayotte</option> |
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<option value="MX">Mexico</option> |
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<option value="FM">Micronesia, Federated States of</option> |
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<option value="MD">Moldova, Republic of</option> |
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<option value="MC">Monaco</option> |
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<option value="MN">Mongolia</option> |
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<option value="MS">Montserrat</option> |
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<option value="MA">Morocco</option> |
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<option value="MZ">Mozambique</option> |
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<option value="MM">Myanmar</option> |
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<option value="NA">Namibia</option> |
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<option value="NR">Nauru</option> |
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<option value="NP">Nepal</option> |
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<option value="NL">Netherlands</option> |
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<option value="AN">Netherlands Antilles</option> |
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<option value="NC">New Caledonia</option> |
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<option value="NZ">New Zealand</option> |
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<option value="NI">Nicaragua</option> |
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<option value="NE">Niger</option> |
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<option value="NG">Nigeria</option> |
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<option value="NU">Niue</option> |
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<option value="NF">Norfolk Island</option> |
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<option value="MP">Northern Mariana Islands</option> |
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<option value="NO">Norway</option> |
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<option value="OM">Oman</option> |
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<option value="PK">Pakistan</option> |
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<option value="PW">Palau</option> |
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<option value="PS">Palestinian Territory, Occupied</option> |
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<option value="PA">Panama</option> |
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<option value="PG">Papua New Guinea</option> |
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<option value="PY">Paraguay</option> |
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<option value="PE">Peru</option> |
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<option value="PH">Philippines</option> |
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<option value="PN">Pitcairn</option> |
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<option value="PL">Poland</option> |
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<option value="PT">Portugal</option> |
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<option value="PR">Puerto rico</option> |
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<option value="QA">Qatar</option> |
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<option value="RE">Reunion</option> |
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<option value="RO">Romania</option> |
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<option value="RU">Russian Federation</option> |
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<option value="RW">Rwanda</option> |
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<option value="SH">Saint Helena</option> |
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<option value="KN">Saint Kitts and Nevis</option> |
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<option value="LC">Saint Lucia</option> |
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<option value="PM">Saint Pierre and Miquelon</option> |
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<option value="VC">Saint Vincent and the Grenadines</option> |
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<option value="WS">Samoa</option> |
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<option value="SM">San Marino</option> |
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<option value="ST">Sao Tome and Principe</option> |
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<option value="SA">Saudi Arabia</option> |
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<option value="SN">Senegal</option> |
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<option value="CS">Serbia and Montenegro</option> |
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<option value="SC">Seychelles</option> |
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<option value="SL">Sierra Leone</option> |
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<option value="SG">Singapore</option> |
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<option value="SK">Slovakia</option> |
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<option value="SI">Slovenia</option> |
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<option value="SB">Solomon Islands</option> |
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<option value="SO">Somalia</option> |
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<option value="ZA">South Africa</option> |
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<option value="GS">South Georgia and the South Sandwich Islands</option> |
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<option value="ES">Spain</option> |
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<option value="LK">Sri Lanka</option> |
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<option value="SD">Sudan</option> |
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<option value="SR">Suriname</option> |
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<option value="SJ">Svalbard and Jan Mayen</option> |
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<option value="SZ">Swaziland</option> |
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<option value="SE">Sweden</option> |
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<option value="CH">Switzerland</option> |
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<option value="SY">Syrian Arab Republic</option> |
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<option value="TW">Taiwan, Province of China</option> |
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<option value="TJ">Tajikistan</option> |
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<option value="TZ">Tanzania, United Republic of</option> |
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<option value="TH">Thailand</option> |
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<option value="TL">Timor-leste</option> |
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<option value="TG">Togo</option> |
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<option value="TK">Tokelau</option> |
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<option value="TO">Tonga</option> |
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<option value="TT">Trinidad and Tobago</option> |
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<option value="TN">Tunisia</option> |
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<option value="TR">Turkey</option> |
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<option value="TM">Turkmenistan</option> |
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<option value="TC">Turks and Caicos Islands</option> |
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<option value="TV">Tuvalu</option> |
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<option value="UG">Uganda</option> |
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<option value="UA">Ukraine</option> |
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<option value="AE">United Arab Emirates</option> |
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<option value="GB">United Kingdom</option> |
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<option value="US">United States</option> |
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<option value="UM">United States minor Outlying Islands</option> |
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<option value="UY">Uruguay</option> |
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<option value="UZ">Uzbekistan</option> |
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<option value="VU">Vanuatu</option> |
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<option value="VE">Venezuela</option> |
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<option value="VN">Viet nam</option> |
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<option value="VG">Virgin Islands, British</option> |
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<option value="VI">Virgin Islands, U.S.</option> |
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<option value="WF">Wallis and Futuna</option> |
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<option value="EH">Western Sahara</option> |
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<option value="YE">Yemen</option> |
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<option value="ZM">Zambia</option> |
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<option value="ZW">Zimbabwe</option> |
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</select></td> |
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</tr> |
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</table></form> |
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</body> |
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</html> |
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