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The information on this form marked with an asterisk (*) must be provided. It will be digitally processed in order to handle your request. In compliance with the French Law on Computer Technologies and Civil Liberties of 6 January 1978 amended, you have the right to access and rectify any and all personal data concerning you. You may exercise this right by contacting ANSES's computer technologies and civil liberties liaison directly by email at You also may, with legitimate reasons, revoke your consent to the processing of all data concerning you.


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Note : Applications will be processed in order of arrival. Thank you for your understanding.

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