| MEDICAL FITNESS CERTIFICATE MEDICAL REPORT (This document was adopted trom Saipem company and weed only for Sapom Clientisubcontrsetor ) Sepia Occupational Health|Center | MEDICAL FITNESS CERTIFICATE |r 2 cae UX Guidelines, Satpem Corporate Standards OPR-COR-HE-HLT-O0l-E, STE-CORMITELE DO! Leaien i actontce wi Me ee Ceadenes on medical examination Full name inves step Date of Birth Occupation M. BAPIANSAH 07/08 / 1251 list oplcER This Health Certificate is valid until: 2 AUS 2013 hit 2 offshore wénshore u Fit with prescriptions and/or restrictions permanent © temporary for months. o Unfit 1 permanent temporary for months Specify reserepos and/or restrictions Af ‘Applicant's si fe in the Doctor's presence Place Day, Month, Year potoP STON Sad Lata G, BALATKARIMUN: 23 AUG 2022 Employer must provide the personal protective equipment specific to the activity