PRENUPTIAL MEDICAL CERTIFICATE

I, the undersigned surgeon ___________________________________________, legally

authorized to practice said profession, with professional license number ____________, issued by
the Dirección General de Profesiones de la Secretaría de Educación Pública, and Registration
before the Secretaría de Salud number _______________, under oath, CERTIFY THAT:

A thorough examination of ____________________________________ has been carried

out.

And having ascertained the identity of said person, I hereby inform you that the methods
governed by the lex artis of medical science were used, including the Wassermann and Kahn
reactions, of which the original issued by the laboratory ________________________, which is
authorized by the Secretary of Health of the State, is attached, and such tests show that the
person in favor of whom this certificate is issued, does not present a sexually transmitted disease
or any other disease that constitutes a legal impediment to marriage.Such tests show that the
person in favor of whom this certificate is issued, does not present any sexually transmitted
disease or any other of those that constitute a legal impediment to contract marriage.

THIS CERTIFICATE AND THE ATTACHED LABORATORY STUDIES CEASE TO BE VALID AFTER FIFTEEN
CALENDAR DAYS FROM THE DATE OF ISSUE.

For the legal purposes that may be convenient for the interested party, this certificate is
issued in the City of Zacatelco, Tlaxcala on February twenty-eighth, two thousand sixteen.

Original laboratory studies dated February twenty-fifth, two thousand sixteen are
attached.

PHYSICIAN'S NAME, SIGNATURE AND STAMP

Note: this certificate is not valid if it presents erasures or amendments, if it does not accompany
the laboratory studies or if they are crossed out or amended, only one legible font and ink must be
used.