a, | HITHM MOHAMMED ‘ABDO ABDULLAH r Name)“ AL-GOBAHT Sete a } Present mailing address Bg weER ‘Nationality (or Area) {Ezeh item musi be answered “Yes” or "NO “corn SBS tye Typhustever ZG OYs ff fj Bacilaryeysemny GND Yes AILS Poliomycliis No CYes —HELHFILEH Brucellosis Bho Byes Fi R__Diphthevia Yes SEAEATSR Viral hepat io Yes BH Scarlet Mo OYes eas Pussperal sireptococeus infection Ja 2% Relopsing fever Zo Cres oe, no OYes | ‘pata ‘Typhoid and pararyphoid fever ‘Oyes | BARGRAHEEK Epidemic cerebrospinal meningitis ZNo DYes ARE: LEAS EBB | | Do you have any of the following diseases or disorders: ‘endangering the public order and security? (Esch item must be answered “Yes! fo Ges oie Toxicomani | HATE, ‘Mental confusion Dyes | SRR Psychosis: BUI Manic paychosi go Oves | EMU Paranoid psychosis 2% OYes | iy fo OYes | ae | em aR [i [a> DE | fees 17! cM & xl Ke a mmitg RAE Lo Development Fz ah & SRE Nouristmens “EPP | Neck | RHEBED 2 ] 1 Vision ARG | Comected vision ae | Eyes =f HEA ee = z Colour sense ay |i e i zx T R is to é j @ | ii i an Eg tgs eg | Abtomen LE QF | CF a renege —_— Pap are fe |! [ee| Se een | Fos 3 Fe | FF ie @ eens JE ie ‘ : | tue | HBX ECC MBE E a5 Gees) GB 5 Ca |". Chest X-ray exam ae a Xny | MSaOA For Has cos 65 Zi Can reed remy (aS ita. / ‘ape. o 1 Labeciiy Sa Xx Sehun fir syPhilis (ettached test report of Yeni Ans Sets) | U7 eg ative: Ke Gy = | RBRA F IAIN AIEE OLA | ‘None of the following diseases of disorders found during the present examination. ' 2a Cholera Yes% — Veneveal Disease | BEIM Yellow fever BSBGEE Lung tuberculosis | MBE Plague em AIDS Leprosy HARDER Psychosis Official Stamp