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Medical Certificate - Template 2023-24

medical

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The gate of hope
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99 views1 page

Medical Certificate - Template 2023-24

medical

Uploaded by

The gate of hope
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Information about the Physician issuing this certificate:

Full name: ………………………………………………….


Name of clinic (if applicable): ………………………………………………….
E-mail address / phone number: ………………………………………………….
Official stamp:

Date ……………………………………

Medical certificate
for the purposes of university admission

I certify that I have carefully examined Mr/Ms ………………………………………………….,


born on …………………….………, passport number ……………………………….
Based on the medical examination, I certify that he/she is in good mental and physical health
and is free from any conditions which may prevent him/her from taking up higher education
studies.
Additional comments (optional):
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

………………………………………………
Physician’s signature

__________________________________________________________________________

Applicant’s statement:
By submitting this document for university admission purposes, I declare that it is true
and correct.

………………………………………………
signature of the Applicant

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