ors.evam Bratt REPUBLIC OF SOUTH AFRICA DEPARTMENT OF HOME AFFAIRS. MEDICAL CERTIFICATE CONDITIONS OF A RECURRENT NATURE though the person(s) may be generally in a good state of health at the time of the examination, it would appreciated if the medical officer/practitioner could furnish details of any disease, condition or detect ihe person(s) has/have sutfered and whieh might recur, | hereby certty that | have examined the following person(s): 1 5 2 8 3 2 Ae oo ; 8 and tnd himMneithem— (2) not mentally disordered* or physically defective in any way; (b) not suffering trom leprosy, veneral disease, trachoma, or other infections or contagious condition; (©) generally in a good state of health; ‘except forthe following defects observed: (Please type or print) Name of person(s) Details regarding the disorder, disease or lsabity the sarousness thereof and the treatment if any, prescrbedirecommendes Official stamp and adress of medical officen/ ‘practiionenfrospital Signature of medical officerfractiioner Date. * "Mentally disordered” includes th following 200-290 Al payoosos Sco Netroves. 50) Parsonaty orders 03-304 Addetone 08 Bohaveur dtubanoos of cithood. 310-815 Al fom of meta stardaion Epiepsy and a ater forms of degeneration ofthe canal nevous sytem.