Emergency Contact Form for Maurice Bedminster, LSJE LLC

LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 Phone: [REDACTED] E-mail: thesaintjames.group@gmail.com

EMERGENCY CONTACT FORM

Today's Date: 4-16-2019 Start Date: 3-25-2019

Employee Name: Maurice Bedminster Date of Birth: [REDACTED]

Physical Address: [REDACTED] 67 Thomlav U.S.V.I Mailing Address: [REDACTED] 86 Thomas U.I 00802

Cell Phone: [REDACTED] Phone (other): [blank]

E-mail: [REDACTED] Marital Status: Single

Title/Position: [blank] Driver's License No: [REDACTED]

Allergies or Health Concerns: N/A Blood type: [REDACTED]

Current Medications: N/A

Doctor's Name: Rosal Doctor's Phone: [REDACTED]

Doctor's Name: [blank] Doctor's Phone: [blank]

In case of emergency, please contact: Name: [REDACTED] | Relationship: Friend | Phone: [REDACTED] Name: [REDACTED] | Relationship: Brother | Phone: [REDACTED]

This information is for your safety and the safety of others.

Names mentioned: - Maurice Bedminster — Employee at LSJE, LLC with start date March 25, 2019 - Rosal — Medical doctor listed on emergency contact form