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MEDICAL FITNESS CERTIFICATE MEDICAL REPORT (ris document was adopted rom Ssiper Comma ‘and used only for Saipert ‘cliensubeontractor ) ) © KLINIK UL MEDILAB (occupational Health fenter MEDICAL FITNESS CERTIFICATE fa & Gas UK Guidelines, Saipem Corporate Standards 08 To HRCHLT-001-£, STO-CORHLTCH-00%-y {sued in accordance with tate erin Guidelizes on medical examination Full name ceckienop) Date of Birth Occupation Ramis — Pengaeibuan 03 4979- Weider~ ‘This Health Certificate is valid until 21 AUG 2023 ft o offshore waffshore fiptions and/or restrictions a permanent temporary for moni Cr Fit with presi 5 temporary for months co Unfit © permanent Specify prescriptions and/or restrictions .../ = FIT TO.WORK ‘pplican’’s| ea ein the Doctor’ presence Place ay, Month, Yeor ar DALAT KARIMUN 92 AUG 2022 Doctors stamp and signature Employer must provide the personal protective equipment specific to the activty

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