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“ ee INTERNATIONAL CERTIFICATE” OF VACCINATION OR PROPHYLAXIS ‘This ito cecfy chat name] p/P fA date ofbinh 38. “ sida ‘has on the datindicatd been vaccinated or recived prophylaxis pins tame of ase o condition) MENIN' be {in accordance with the International Health Regulations. 5 CERTIFICAT® INTERNATIONAL DE VACCINATION. (OU DE PROPHYLAXIE "Nous certfions que [nom) née) le cet de nationale... = document didentifcaton atonal leeas échéane done a signacure sie 4 6 vaceiné(e) ow argu des agents prophylacriques la dare indiquée contre: (nom de b maladie ou de affection) desexe conformément au Réglement sanitaice international, ‘Vaccine o Date urcand profesional | Maufaccurer Oficial samp of the | ee | | foes vg nin eer Cache’ Signature cx tite da Fabs da vaccin ou ‘cae dicen expontable BeTagene poy See cnc PEs. VemEninGUlACAy 21/1/20. ToTSUG335AD | 57 1ZR2E gig 2s nes eo SAGE xgeei? 2 | SEa5 ees26a 3 geet * Requirements for validity of certificate on page 2 No N UL ‘sap seri | "Voir os conditions de vai a page 2

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