You are on page 1of 1

" - -~ . .. . ··- ~ . . . . . . . . . . . .. - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . .. . . . . . . . . . . . ..... . . . . . .. . . . . ...... : . -------- - - - .. . . . . . .. . - · . ... - .. .. . - .. _ _ .. · · - 0 .. . . • • . . .... . • • - - o.. . .. - - .... ... .. o•• 0 - . .. .. . - ... . ~ ;· · ·- . -- - - • • - ...

MUNICIPAL CORI;ORATION OF GREATER MUMBAI


PUBLIC HEALTH DEPARTMENT

Certificate of o·raf Polio Vaccination for International Travelers


(vafi,; for one ye~r from date of vaccination)
Name: ABH\N{\V PANDE'( Sex: J1..AL E
Mobile No. S 1'2.1 €955 6~ Ern a it to: a.bhln~vp · eee1s@ a=mwl· com _·
PasspC?.rtNo. P391g046 DateofBirth/Age . 2.7/Wl~92- J 25'-/.-d -.
Address: I 14, MA J OR.OlANJ; THA1 HE.RI 8A2AR 1
~ VL.IfU::!P.Jl)L ___ _ _ __

\1 r ·-r AR e_R RDESH -1-.lg'o oi , INDIA ----- - --


Date of Name · oqBatch Number ot Ncfme, Signature & Stamp -or------ ---
Vaccination Manufacturer- Vaccine Designated Officer ·
~------+---------- ---~----~~~--~----------------
. ~a-t~ _N---1) -
1b t6.- m-e_ d ~\~oBI c1-- •

ff\M ~ ~ 8/t'>r
t~f ~ cq- !13
_...
' - - - - - - ' " - - - - . . . L __ _ _ _ _ _ _ _ _ . l - - - - - - - ' - - · · - -----·- ····--·-·-·· -··-· · ····- ·-·- ---- - ···-·· . . --- - - -
!:\EF '- M\Word fik \lcttcr> 101~ . doc

You might also like