(Occupational Healt! MEDICAL FITNESS CERTIFICATE MEDICAL REPORT (This document was adopted from Saipem company and used only for Saipem ‘lientsubeontractor ) ILA Center \ssued in accordance wit MEDICAL FITNESS CERTIFICATE Oi & Gas UK Guidelines, Saipem Corporate Standards Ora-cOR-HA- IMO and STCW Guidelines on medical examination -€, STD-COR-HLTCLI-O01-f, Full name (i sieck iene Date of Birth ‘Occupation Specify prescript Muhammro Ariée 4intirg W-06 ac. Pitter. ; OB FAR This Health Certificate is valid until: __ AR 2028 0 Fit © offshore wénshore Fit with prescriptions and/or restrictions permanent temporary for months o Unfit S permanent 5 temporary for months os. sons and/or restrictions FITWITH PRESCRIPTION Applicant's signatu Place 76. BALAT KARIMUN KLINIK 2 in the bostor's presence bay, Month, Year inet Doctor's stamp and signature 0.9 MAR 2022 Employer rust provide the personal protective equipment specific to the activity