ors.oneee set REPUBLIC OF SOUTH AFRICA DEPARTMENT OF HOME AFFAIRS MEDICAL CERTIFICATE CONDITIONS OF A RECURRENT NATURE | Although the person(s) may be generally in a good state of health at the time of the exemination, it would be appreciated if the medical officer/practitioner could furnish details of any disease, condition or defect { [the person(s) hasmave sutfered and which might recur. | hereby certty that I have examined the following person(s): and find hievherthem— (@) 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 cisabily the seriousness thereof and the treetment, f any, prescribedreconmended Offical stamp and address of medica aficer/ ‘Practtionerhospial Signature of medical ofcerfpracttioner Date. Tn code = “Mentally disordered” Includes the folowing: 20-299 Al payee 500 Newroues. 501 Porenaity dear, 305-304 Addotons 508 Behaviour disturbances of chidhoos. ‘S10-315 Al foe of ment rtaraton. 20-848 _Eplepsy and al ter trms of degeneratien ofthe central enous s/stem.