Sample Medical Certificate

Medical Certificate

September 16, 2001

Certified that I have examined Mr. Renato L. Santiago of ABC Corporation, Pantalan Bridge, Orani, Bataan.

He is physically and mentally fit to proceed aboard and work Saipan.

Free from the following illness:
–    HIV/AIDS
–    Hepatitis B and C
–    Tuberculosis
–    Syphilis

X-ray chest is clear. His identification mark are under a cut mark on right face and a mole on the left side of upper eye.

Attested by:

Dr. Eduardo K. Malonzo
Agency Attending Physician