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Yellow Fevar

This document is an International Certificate of Vaccination from the World Health Organization. It was issued to TAN.D.L:L .. A:ks.t\E.S .. $.H9.I.LE&H ..... , an Indian national with passport number P.I.'t.S$.?.."P. .~.1 ...CPf.(..., who received a vaccination or prophylaxis for an unspecified disease or condition at the Community Health Centre in Moti Daman, India on the listed date in accordance with international health regulations.

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Aksu Tandel
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142 views2 pages

Yellow Fevar

This document is an International Certificate of Vaccination from the World Health Organization. It was issued to TAN.D.L:L .. A:ks.t\E.S .. $.H9.I.LE&H ..... , an Indian national with passport number P.I.'t.S$.?.."P. .~.1 ...CPf.(..., who received a vaccination or prophylaxis for an unspecified disease or condition at the Community Health Centre in Moti Daman, India on the listed date in accordance with international health regulations.

Uploaded by

Aksu Tandel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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World Health
Organization 1fffif 'fl '(q;p(
GOVERNMENT OF INDIA
GOVERNMENT DE L'INDE

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MINISTRY HEALTH AND FAMILY WELFARE,

l MINISTER DE SANTE PUBLIQUE

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YELLOW FEVER INOCULATION CENTRE,

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COMMUNITY HEALJ"H CENTRE, MOTI DAMAN,
LE JAUNE FEVRE INOCULATION CENTRE
CHC DAMA'O GRAND

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INTERNATIONAL CERTIFICATE OF VACCINATION
CERTIFICATE INTERNATIONAUX DE VACCINATION

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Issued to } 1.B/Y..DG.L.. B.KSH.'G£ .. $HfUW)j.J3.Bf1t
Delivre a
'q"R q"??' ~ 3f'tm
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Passport No. or
Travel Document No. } ....... 3 0..3l..t13~ ...................
:f.........
Numero du passport
Ou de Ia piece
justificative
INTERNATIONAL CERTIFICATE* OF VACCINATION CERTIFICATE* INTERNATIONAL DE VACCINATION
OR PROPHYLAXIS OU DE PROPHYLAXIS
This is to certify that [name1TAN.D.L:L .. A:ks.t\E.S .. $.H9.I.LE&H ..... No us certifions que (nom] ................................... ........................................ .
f3h~
date of birth :..... :~.l-:-:.Q.,f.":-: ..2-0.D~ ...... Sex :.M.BL.f: ......................... . ne(e) le ........ .......................... de sexe ............................................. ....... ..

Nationality :.. ~N .D.1:.fT.N .................................................................... . et de nationalite ................ ............................................. ..

national identification document, if applicable .. P.I.'r.S$.?.."P. .~.1 ...CPf.(... . document identification national, le cas echeant... .. .................................. .

whose signature follows ....... ...... ................ .. ...... ....................... ......... .. .... .. don't Ia signature suit .. ......... .............. .. ....... ...... ......... .. ............ ................ .. .

has on the date indicated been vaccinated or received prophylaxis against a ete vaccine(e) ou a recu des agents prophylactiques a Ia date indiquee
<'

(name of disease or condition) conte: (nom de Ia maladie ou de !'affection)

········ ········ ······· ······ ··· ·· ····· ························· ···· ·· ·· ···· ········ ······················ ·········· ·

in accordance with the International Health Regulations. conformement au Reglement sanitaire international

Signature and Manufacture and Certificate valid Official stamp of


Vaccine or prophylaxis professional status of batch no. of vaccine or from : the administering
Vaccine ou agent Date supervising clinician prophylaxis until : center
prophylactic Date Signature titre du Fabricant du vaccin ou de Certificate valable a Cachet official due
clinicians responsible lagent prophylactique et partir due : centre habilite
numero du lot Jusqu au :

Dte. Medical & Health Serv.cte


'QT. 311'. if;. Gllvr/P.H.C.
Da

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