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Yellow Fever

This document is an International Certificate of Vaccination or Prophylaxis, certifying that an individual has received a vaccination approved by the World Health Organization. It must be signed by a qualified clinician and include the official stamp of the administering center to be valid. The certificate details the vaccination type, dates, and other relevant information, and is only valid until the specified expiration date.

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Roy Mathew
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287 views2 pages

Yellow Fever

This document is an International Certificate of Vaccination or Prophylaxis, certifying that an individual has received a vaccination approved by the World Health Organization. It must be signed by a qualified clinician and include the official stamp of the administering center to be valid. The certificate details the vaccination type, dates, and other relevant information, and is only valid until the specified expiration date.

Uploaded by

Roy Mathew
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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This certificate is valid ony ifthe vaccine or prophylaxis used has bcen approved by the

Sr. No. 28557


World Health Organization.
This certificate must be signed in the hand of the clinician who shall be a medical GOVERNMENT OF MAHARASHTRA

Practitioner or other authorized health worker, supervising the administration of


VACCINATION CENTRE
vaccine or prophylaxis.
DEPARTMENT OF COMMUNITY MEDICINE
The certificate must also bear the official stamp of administrating centre however, this GRANT GOVERNMENT MEDICAL COLLEGE& SIR J. J. GROUP OF
HOSPITALS
shall not be an accepted substitute for the signature. Any amendment of this certificate or BYCULLA, MUMBAI - 400008. (INDA)
erasure or failure to complete any part ofit, may render it invalid. Phone: 022-23735555 Extn.: 2414/ 2309 Email: vaccines. gmcjjh@ gmail.com

The validity of this certificate shall extend until the date indicated for the particular
vaccination or prophylaxis. The certificate shall be fully completed in English.

qEat: o?R-R20I444 " faraR: RY/ROR "HA: vaccines. gmcjjh@gmail.com

INTERNATIONAL CERTIFICATE OF VACCINATION OR PROPHYLAXIS

Name Brii ALEX AIiN


Nationality

National
identification
document / No. SI0 9s 3
INTERNATIONAL CERTIFICATE OFVACCINATION OR PROPHYLAXIS

This is to certify that (Name) BiT ALEY AI Date of Birth Sex MALE
feiT
Nationality National identification document, if applicable SIZo19s3
Whose signature follows ake
YELLOW FEVER in accordance with the
has on the date indicated been vaccinated or received prophylaxis against: (name of disease or condition)
International Health Regulation

Signature and Professional Manufacturer and Certificate valid Official stamp of the
Vaccine or Date
status of supervising clinician Batch no of Vaccine From - Until administering centre
Prophylaxis or Prophylaxis
BIO-AOFHES
INSTIFUTUDYECNOLO6IA
lEM IMUSBBiG1EcIcos
AV BRASIL 4365-MANGUINHDS
-RIO DE JANEIRO-RJ artmant COmmunity Me&
dicin
MFG. DATE (°|019
EXP DATE (2022 GrarOx
13000290 LOT NO (90Vfeo14+
YELLOW FEVER
Dr. Nikita G. Rajadhyak$ha
MBBS, M.D.
MMC, Reg. No: 2013-06-2B61 Gove
Assistant Professor CERTIFICATIQN
T/ FROM
VALID Ceu
Dept. of Community MedicBne GroU

Grant Govt. Medical Colleg &


Sir J. J. Group of Hospitals,
Byculla, Mumbai -400 00.
qtajUNTIL 15.0CI
2020 dica Colege &S
J.J.

LIFE OF PERSON VACCINATED

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