Date: SP SP Address Number

Full Gender: Family Given

Health Health
IMPORTANT: of
alsoberesult
supplied.
this
ZIMBABWEAN
Nationality:
residential
certificate in name name(s)
a in of
Professional
Professional delay the
accompanying
U (as
You UK:address: Male (as
for to shown
your must shown
their
Signature: Name: journeycarry
records. 54 X in in
children passport):
Female Certificate
ID No:
No:SP
FOREL passport):City/Town:
this
as
Pre-DepartureUK
certificate
Ifyou STREET, under
your
04/10/2023 BLESSING
THUSIDR may
chest
be
with 11
CHIDZIWA
required PassportNo: Birth:
BONEAROEN703794
years Date of GRACE
X-ray PRETORIA
you, 141791
shows in of
to
your age:
undergo PARK
abnormality (DD/MM/YYYY)
13/12/1981
hand
Medical
Hatmed
Centre KEMPTON Tuberculosis
Programme
Detection
Tel: Street
Hilda
454
luggage,
the
(012)
Hatfield
Pretoria tests medicalHAT
requiring
362 again.when PARK
7180
follow-up,Upon you SOUTH Certificate
Medical centre
travel
arrival
AFRICA
we to "
Visa Applicant's
Category: Signature:
Date: the
will in
the UK
mediese
also
and
UK Country: Expiry
Date: Date:
Issue MED
give you
present
a
shouid
copy
X-Ray:
Chest Sputum
sentrum
O U NO
U
it
of
register to D evidence
the the PregnantFamily
Referral Chest Under
04/10/2023 04/04/2024
SOUTH 04/10/2023
Test: AFRICA
HEALTH chest
Immigration
with X-Ray 11 contact
letter of
x-ray years active N
a &
General given
interaction with
Normal
UNot
Done Not
AND and of
Officer age pulmonary
x-ray to tuberculosis Done
CARE Practitioner applicantundergone Immigration &
UK
interpretation on
with
arrival. TB Negative Visas
VWORKER applicant
health
(GP)
Failure
and and assessment UAbnormal
VISA supply to
this
do
should so
a
copy wil