Bit Form

Embassy of the Republic of Liberia – Abuja, Nigeria

Emergency Assistance Request Form for Liberian Citizens in Distress

Purpose: This form is for Liberian citizens residing in or visiting Nigeria who are experiencing distress and require urgent assistance from the Embassy. Information submitted will help the Mission respond promptly and appropriately. All information is confidential and used only for consular purposes.

SECTION A: PERSONAL INFORMATION

Full Name:

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Gender

Male

Female

Other

Liberian Passport Number

Current Location in Nigeria

Phone Number (Nigerian Phone Number)

Alternative Phone Number

Email Address:

SECTION B: EMERGENCY DETAILS

Nature of Distress / Emergency (Select all that apply):

Detention / Arrest

Threat to Safety or Security

Lost Passport or Travel Document

Stranded / No Accommodation

Scam or Fraud-Related Issue

Financial Distress

Domestic or Community Conflict

Other (Please specify)

(Please specify):

Describe the Situation (What happened?)

When did the emergency occur?

Are you in immediate danger?

Yes

No

Have you contacted local Nigerian authorities or emergency services?

No

Yes

(If Yes) Name of Agency/Officer:

SECTION C: ASSISTANCE REQUESTED

Type of Assistance Needed

(Select all that apply):

Consular Intervention

Communication with Nigerian Authorities

Medical Referral or Support

Passport/Documentation Help

Temporary Accommodation Referral

Contacting Family in Liberia

Legal Aid Referral

Financial Support Assessment

Other (Specify)

Urgency Level:

Critical (Immediate life or safety threat)

High (Needs assistance within 24 hours)

Moderate (Needs assistance soon)

Low (Seeking guidance only)

SECTION D: EMERGENCY CONTACT INFORMATION

Emergency Contact Person:

Relationship:

Phone Number

Address

Should we contact this person if needed?

Yes

No

SECTION E: DECLARATION

I hereby confirm that the information provided above is true and accurate. I understand that the Embassy will use this information solely for consular and emergency support.

Signature

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