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INTERN.ATIOML CERTIFICATE OF VACCINATION OR REVACCINATION
AGAINSTCHOLERA
CERTIFICATE INTERNATIOML DE VACCINATION OI.' DE REVACCIMTION
CENIRE
IACHOLERA

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This ls !o cenify lhat )
JE Soussigno (e) corlifo que

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wtrors Con8furs folloivs ) Sex )-s.D.rc_
dont la slgnatuIg suit So€
fi rsri Ti lrtc 6lti urta cqd gr66ra trt r
has on th€ dde indicatrd bcen rrrcdndcd or r€vaccioaled agsinst cfiolora:
E ste vacdne (e) ou Fvacdne (B) Co r*{e dtolora a la &tg lndlquee.

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Sler.tur! rdp(lh.doml !b[lt of
. Dale vlcdnriot
Signatult atquiua !6rslonal. du
f\ecclneteur
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Continued overlEaf-Suire au verso

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