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    Samara Contracts Sdn Bhd is located at No 32A, Jalan Nusaria 1, J/3 Taman Nusantara, Gelang Patah, 81550. The company can be contacted by phone at 012-5005163 or email at samaracontractsjb@gmail.com. The document appears to be a medical certification form for fitness to work, requiring the name and NRIC/passport number of an individual. A doctor would examine the individual and relevant health information to determine if the person is fit or unfit for work, and provide any remarks.

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    Samara Contracts Sdn Bhd is located at No 32A, Jalan Nusaria 1, J/3 Taman Nusantara, Gelang Patah, 81550. The company can be contacted by phone at 012-5005163 or email at samaracontractsjb@gmail.com. The document appears to be a medical certification form for fitness to work, requiring the name and NRIC/passport number of an individual. A doctor would examine the individual and relevant health information to determine if the person is fit or unfit for work, and provide any remarks.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    32 views1 page

    Medical Form

    Uploaded by

    nrafiqahanuar
    Samara Contracts Sdn Bhd is located at No 32A, Jalan Nusaria 1, J/3 Taman Nusantara, Gelang Patah, 81550. The company can be contacted by phone at 012-5005163 or email at samaracontractsjb@gmail.com. The document appears to be a medical certification form for fitness to work, requiring the name and NRIC/passport number of an individual. A doctor would examine the individual and relevant health information to determine if the person is fit or unfit for work, and provide any remarks.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
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    SAMARA CONTRACTS SDN BHD

    NO 32A, JALAN NUSARIA 1, J/3 TAMAN NUSANTARA


    81550, GELANG PATAH

    TEL: 012-5005163 EMAIL: samaracontractsjb@gmail.com

    Name : ……………………………………………………………………..

    NRIC/Passport No. : ……………………………………………......

    I hereby certify that I have examined the above-named person on ………………………………………………


    From the information related to health declared by the person, my examination and diagnostic
    tests recorded on medical examination, I certify that this person is

    FIT TO WORK

    UNFIT TO WORK

    Remarks:

    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..

    Thank you,

    ………………………………………..
    (Doctor Signature & Chop)

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