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CERTIFICATE - CERTIFICAT - CERTIFICADO __________________________________________________________ Name/Nom/ Apellido _________________________________________ Passport No./ Passeport Nà/ Pasaporte No. English: To whom it may concern. This is to certify that the above traveller has been supplied with this medical equipment for personal use only in the event of illness, accident or emergency. It has no commercial value. Franc ais: A qui de droit. Ceci est pour certifier que le voyageur cidessus a e te fourni avec du materiel me dical pour usage personnel seulement dans I’e ventualite de maladie, d’accident ou d’urgence. II n’a aucune valeur commerciale. Espanol: Para efectos del interesado. Esta es para certificar que ai viajero nombrado mas arriba, se le ha suministrado con este equipo me dico para uso personal solamente en caso de enfermedad, accidente o emergencia. No tiene valor comercial. Contents/Contenu/Contenido: _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ Stamp/Cachet/Cuno: _________________________________________ ______________________ _____________ Place/Fait a /Lugar Date/Le/Fecha _______________________________________ Signature/Signature/Firma
