KEEP THIS PAPER CAREFULLY FOR 5 YEARS.
VACCINATION.
SECOND SCHEDULE.
FORMS.
FORM No. 1.
No. 12 of 1923.
2737
[ss. 6 (3), 7.]
Hongkong.
Certificate of vaccination for an emigrant.
[s. 12 (1).]
Name..................Sex..................Male Female
Date of this certificate..................
Place of issue..................
Present age of emigrant..................
Number of previous vaccination marks now distinctly visible..................
Number of new vaccination marks made this day..................
Left thumb print of emigrant.
Signature and description of vaccinating officer.
Fee: 20 cents.
FORM NO. 2.
[ss. 9, 10 and 12 (2).]
Hongkong.
Certificate of vaccination other than for a child or an emigrant.
Name..................Sex..................Male Female
Date of this certificate..................
Place of issue..................
Present age of applicant..................
Number of previous vaccination marks now distinctly visible..................
Number of new vaccination marks made this day..................
Signature and description of vaccinating officer.
N.B.-No fee is payable for this certificate. This certificate does not imply that the vaccination operation has been successful. If the person vaccinated wishes for a certificate of successful vaccination, he must apply to the officer vaccinating him at the date, time and place prescribed.
Signature or name in Chinese characters.