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NEGATIVE COVID-{9 PCR TEST CERTIFICATE

GrAy xAc NHAN Au rft.tH vdr covrD-r s eANo KY rHuAr pcR

Date of lssuelNgoy cdp:24/A812A70

pATr E NT DE M oG RAp utcs I r u 0 r't e n rtt B E N u N u A r't

Fuli name/,1o vd ten:
D0B/fuqov lhanq rtart sinlt' 6enderlGisitinh:
Nationality/Qudc tith : Vietna m Passport number i HA ch i6 u :

lD card number {for Vietnamese citizen)/CMND/fhd cdn caoc (danh cha cang ddn ViSt {"!am):
neq tllt address in Vietnam/Oia chi lvu UA UiVi€t Nam: ,

Residential address in country af originlDla chiluu trti tqi nadc ngodi:

Planned date of departure from Vietnam {when applicable)lNgdy dal kidn kh&i hdnh tuVi$t Narn (ndu co):

spEcrMEnr f NFORMATTON/ri,6'V6 TtN MAU eENn rUiU

Specimen TypelLoai mdu:
NasopharyngealswablMdu phdt dich mili h&u
Collection datelNgdy tdy m&u: 24/05/202a A6:a1"

TEST ilrrArLSlCNt fliT XfT NGHt€M

F.everse transcriptase poiymerase chain reaction (RI-PCR)/ Phdn xng tdng hgp chudi potymerase saa chep ngtroc
Test Narne/fdn xet nqhi€m: 5eegene Allplex 2019-nCoV
Testing Facility/l/cvl xdt nghi$rn: FV Hospital Laboratoryll(hoa xet nghi$rn {34nh vi6n FV

DTCLARATT0 N I XAC n ff,4/V

This is to certify that the specirnen collected on the stated collection date, from the above-mentioned person was
confiri"rre d NEGATIVE for the SARS-CoV-2 virus at fV Hospital.
{tidy ndy xac nhdn riing ntdu bdnh phdm dtgc ldy tir ngu'oidaqc de cqp otr6n 'taa ngdy n6u trOn, dd cho kd't quc
xet nghi€nt AU fiYU voivi rrtt SARS-CoV-2 tqi BCnh vi€n FV.

this Certificate is valid for 3 days from the date of test result/6 rdy xac nhqn ndy ca gia tri trong vottg j nEdy k6'trr
ngay ca k6't qu& xet nghi|m.

V0 Inrdng Sor, }lD, il&. t0 il0g

General practitioner
Bdc El Ncli Tdng euilt

Fv Hospatolr 6 Nguyen Luong Bong st., Soigon Soulh (Phu My Hung), DisirictT, HCMC - Te| (028) 541 I 3333 Emergency: (028) 541 I 3500