MEDICAL CERTIFICATE FORMAT

(On Hospital’s Business Letterhead)

TO WHOMSOEVER IT MAY CONCERN

This is to certify the following:

Name:

Address:

Age:

Height:

Weight:

Blood Group:

(Your Name) has undergone the Blood, Pathological and Urinalysis tests to clinically
check and identify any known symptoms of Tuberculosis (TB), Hepatitis B and C,
Sexually Transmitted Diseases such as Syphilis, HIV or AIDS. After reviewing the
above tests and medical examination result, (Your Name) was found totally free from
all known communicable diseases and illness.

(Your Name) has also been found medically and physically fit to undertake any type
of supervised and unsupervised work under whatsoever circumstances.

Place of Issue: Date of Issue:

Dr’s Signature: Hospital Seal:

Dr’s Name:

MCI Registration Number: