‘THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH MEDICAL EXAMINATION CERTIFICATE FORM - M.F-M. 14 PHYISICAL EXAMINATION Vision : RT 6/6). LT 6/6) ~~ CORRECT VISION 1 renin > apdlélieted | ENE: ove} Pulse rates 51 Heart... Chest ay 3. Digestive Liver :..5 4 Urinary Tract Sys Kidney: M Spleen Bladder ohn Has the candidate been treated for psychological or nervous illness Has the candidate been successfully vaccinate 6 LABORATORY ANALYSIS. Urine =~ Marco _ \s\} Pregnancy Test- = Microscopy. Serology - Khan Testi... eee - Widal Test: -Elisa Test : -TB Test: This Medical Certificate prove that Mr/Mrs/Miss... a SUFFER NONE OF THE ILLNESS. That may have serious Public Health repercussion ccording to the stipulated in the internal sanitary Regulation ore v Acle Date.2¢\e1\2824 Name/Signature :, Verpsls S Designation AD, 7° MEDICA Ofer : Mazi ma Section...