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MEDICAL DECLARATION FOL NIE DATE OF BRT WE SHOE RRA STATES REGION MALE () FEMWE( sul () warmen( ) | TOURS - | PRSSPORTNG! ‘COUNTRY OF DESTINATION: SINGAPORE POSTION APPLED FOR, {EDO HsTOR as carson, ben gree, sh ia otto Fm maa et ibn coos: ce achuckmark (V7) theme ox - Espey TF YEH Fa oT [| Saar a SRT TT [Fiet Hetackes ———] —] reed rae — Thea Po reget ioe ‘at Del a ag err Dr hPa Tang ts, Fs, ars oe Rests [| aT (hee Ore ‘ate Tas Dsias | STS Sasa ET Tapas, aaa [ GisrEncatnebises | | | Serny estar Denes | (epctay Dewse [Beemer T TepslOaaae es ort atin ce Tuner | ioitaurmeeerery | | Tasca TOS = ‘Sar aia ‘ia ay i Fea Sea V7 Te aT, Ye] 7: Hv yo ovr ben Send a x orpaid fa al owes? 7 ave oo ean toad? t ee Baa EET ORT TO WO OE Fas your wee caret a Be iia or OTST [Ae ave ie you any medal prob, ease or ess [5 yet bata parr eas ot your ena pain Tea [7a yousfnio ey madeaion? 7 Cone: Are yu aig ny nn pentane pesipionnedaion | yea, poset he means) taken bok ke, an th pose and atae ‘rb deca thatthe above infmaton se othe esto ny reed ad bal an understand tat cas be eed vere luna tat wil arto bear all meal expanses chu anything apen tty cena of mploowr Signature of Applicant

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