Loqr LRA Operator Registration Form

Identity number*
First name*
Last name*
Address line 1*
Street name, house/building number
Address line 2
Town
Address line 3*
Postal code
*
Territorial subdivision
Address line 4*
E-Mail*
Mobil number*
Secret Question*

This is used so that the user can identity themselves to the RA operator in the case where he, for example, has lost his card
Secret Answer*
Copy of Identity Document*

This is a file upload of a copy of the identification used. In this case it will be a copy of the National ID card or the passport
Copy of police certificate of contact*

This is a copy of a document from the police to confirm that the user has no police record
CAPTCHA