oTaRe ‘a0e-2003 10.20 ee Fee shod aA LCI se evo Examination Repor 94 654 \R~EIIE Je ella ERMA SS Sia riemiber concerned Examining Data (25H G44). ~S | [Narcotic (Apia pasty 0 Preg.Test — dadetoat| “SS t HBSAD/O0K (vga 4e2n) | F_ [MMR Ab B Genk erTh (i aah | PPp1 O etoasiy | lca} ealralea] ARS Gender Sap hane DIA TRIS | at | et gl Jesve Dae (9291.5) Place OF issue Gaal] PassporiD.No L | Booth issue Date Re G23 G5] Place Of Issue Ges a] Vise No ENEVEPIOEA | ic (ay | Emons No CEST IH] Type OF Work CATER) [Pace OF Work OTE) Ww 50 po ee a yi | Result (n=) ‘Sound | Improper Type OF Disclosure Sound | (a2shgs) “S| [Right eye (8 cay “~S D _|Lefteye (ors ony |e Pe) D [color Test es sat | Ss] Reber aati ene) Oo [ bet ear erPoRiy za) oe,|8F Ss) | Shigetia 2] Oo [chet ere Oy Foucose” haste] Dy | Redomen Tay TT Mataria\Fiaria_ cu 2ste.s4) | ~E) D)_ | Berman DEES A | | HIVE om lea D | Paeds eA 2 /HBSAG este] | Neuro Dis = Say] O yao i 2 [Ant CVG gorse 3 teat | —~E) OD | Herne Cee] oD = [synnts aoe aries a} 5 | Eareniies Gay + o a a o [aneata av [Hoveaa tnt A al Ait yall hy 4747231548 dase dy pal gall pill Sul) ye! DDOEK2304656 (Sy pSille le Ualiy AIS yy yall aay pSule pd! Sau acu in ror Examination = youl oe Examination vail Vocalization .. Aarcend | saya KRERRRRAN INN] ¥ ¢ N|NRRNS| SNS] * Chest X-ray Mantoux Tost | Urine Analysis el o a "18 4 = fans] Phy, asabiiy matey oa 4c D9 ; fay o Major Surgical Operations 3 ( “Define” see - a Clete 4 Narcotics he La ay Te ey pens Toxicology E sare applicants only: sua!) tsi Jatt cyst Ao cheayail (6) ead ga He ae (2) sat yas ae 3 @ Sy atta ett ya ae VORL AB oan oad Taaast ‘Serological Tests . te Gasull Chagall Giga Aaa GW dT GAD gle SLE Gr alae ana phe ly je tt Sree jabs a) : a gt 10:26 1444-10-07 sy Sh sya Gah aie Otel tartan gov.80 pe oA yl se Lea