INTERNATIONAL CERTIFICATE | VACCINATION OR PROPHYLAXIS ‘This certificate is valid only i he vaccine o prophylaxis used has been approved by the World Health ‘Onganization, ‘This cerfcate mast be signed in the hand ofthe clinician ‘who shall be a medical practioner or other authorized Incalth worker, supervising the administration of the vaccine ‘or prophylaxis. The eerfcate mast also bea the official stamp ofthe administer centre; however, this shall not Dean accepted substtate forthe signaure. ‘Any amendment of this erase, or erasure, o flare 19 complete any of part of it; may ender it invalid, ‘The validity of this certificate shall extend unt the date indicate forthe particular vaccination of prophylaxis. The certificate shall be filly completed in English or in French “The certificate may also be completed in another language fn the same document, in addition to either Engh oF French, hageev boas BOQEW000099074' nationality _EALIPINO: ‘ean OR Code wae Bureau ot Ouarartine Oil APP or Webel ‘national identification document, fapplieable | PASSPORT NO-P86455228-— i ae aaa accinated oF received propane against: (name of disease orcondtion) SALVADOR JR. f, ESTIDOLA é i 5 é £ : i z A a 3 he ° i 2 g é z z 3 : 2 8 3 2 : i Covi 19 date oft 29 NOV. 1993. has on the date ncested been tn sccordance with he International Health Regulations. | This Is to certity that eases tans ees v