Lateral Flow (Antigen) Self-Test Photo

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ReferenceNumber: Unique Test No: Departure Location:

BTHED6208915 Robert William Phipps BALFT101692 United Kingdom

PERSONAL INFORMATION
FIRST NAME LAST NAME DATE OF BIRTH SEX

Robert Phipps 12-04-1969 Male

VACCINATION STATUS ETHNICITY EMAIL PHONE

1st & 2nd Dose White phippsconstruction@yahoo.com +44 7989 574918

PASSPORT NUMBER

562971817

COUNTRY HOME CITY POSTCODE HOME ADDRESS

United Kingdom Guildford Gu12uw 23 Finches Rise

TRAVEL INFORMATION
DEPARTURE LOCATION ARRIVAL DATE TYPE OF TRANSPORT FLIGHT/VESSEL/TRAIN NO ARRIVAL LOCATION

United Kingdom 14-06-2022 Airplane BY5240 Spain

TEST INFORMATION
LATERAL FLOW RAPID ANTIGEN TEST

BARCODE NUMBER DATE/TIME SWAB TAKEN DATE VERIFIED CERTIFICATION RESULT DATE/TIME COVID SYMPTOMS AUTHORISED BY

BALFT101692 12-06-2022 18:24 12-06-2022 18:31 12-06-2022 18:31 NO Dr Tim Chesser

N E G AT I V E

Your coronavirus (COVID-19) test result is negative. It’s likely you were not infectious when the test was done. If you develop symptoms of coronavirus, it is advised that
you take a PCR test. If you have any of the main symptoms the public health advice is to avoid contact with other people where possible. For more information visit
https://www.gov.uk/coronavirus

Date Printed
Dr Tim Chesser MBBS FRCS 12-06-2022 18:31
Medical Director, Breathe Assured

Get in Touch:
(+44) 0203 677 0009
www.breatheassured.com
Breathe Assured is a UKAS registered and government
approved private test provider for travel and general Breathe Assured is the trading name of
Covid testing. ISO 15189 Medical Assured Group Ltd Company number 12991100