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Appendix D
Medical certificate

This is to certify that

Name...............................................................................................................................................................

born on................................................................in...................................................................................

tested negative for SARS-CoV-2 on................................ (date on which test was carried out)

at........................................ (time at which test was carried out):

by means of a molecular biological test (test carried out at the following clinic:

. ..........................................................................................................................) or

by means of an antigen test, or

has recovered from being infected with SARS-CoV-2 and been free of the most recent case of

infection since................................; or

was vaccinated with the vaccine..................on the following dates:

First dose on: …………………………………………………………………….

Second dose on: …………………………………………………………………..

.............................., on..............................
place, date, signature and stamp of the certifying medical doctor

Unterzeichner serialNumber=932783133,CN=Bundeskanzleramt,C=AT
Datum/Zeit 2021-05-17T22:52:25+02:00
Informationen zur Prüfung des elektronischen Siegels bzw. der elektronischen
Prüfinformation Signatur finden Sie unter: https://www.signaturpruefung.gv.at
Informationen zur Prüfung des Ausdrucks finden Sie unter:
https://www.bundeskanzleramt.gv.at/verifizierung

Hinweis Dieses Dokument wurde amtssigniert.

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