| MEDICAL FITNESS CERTIFICATE MEDICAL REPORT {This document was adopted from Saipem company and used only for Saipem ‘chentisubcontractor ) \Aqe KLINIK ALL MEDILA [Occupational Health|Center MEDICAL FITNESS CERTIFICATE issued in accordance with il & Gas UK Gudelines, Saipem Corporate Standards OPR-COR-HR-HLT O04 5, STO-CORHLTELI-001-1, IMO one STCW Guidelines on medical examination Fall Rare peomaeneh Date of Birth Occupation Orie Mucabarat 09.03-(9}5 *Forewon Weider 22 AUG 2023 This Health Certificate is valid unti Fit 2 offshorewonshore \J Fit with prescriptions and/or restrictions yfermanent © temporary for months. D permanent 0 temporary for months 0 Unfit Specify prescriptions and/or restrictions [ FIT.WITH NOTE 1 ‘Applicent’s signature ia the Dector’s presence Day, Month, Year Place Doctor's stamp and signature AeBALATKARIMUN 9 3. yg 7097 Employer must provide the personal protective equipment specific to the activity