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KEEP THIS PAPER CAREFULLY FOR 3 YEARS.
Hong Kong.
VACCINATION.
SCHEDULE:
FORMS.
FORM No. 1.
No. 12 of 1923.
1613
[ss. 6 (2), 7.]
Certificate of vaccination for an emigrant.
Name
Date of this certificate
[s. 12 (1).]
Male ..... Sex Female
Place of issue
Present age of emigrant
Number of previous vaccination marks now distinctly visible
Number of new vaccination marks made this day
Signature and description of vaccinating officer.
Signature or name in Chinese characters..
FORM NO. 2.
[s. 12 (2).]
Hong Kong.
Certificate of vaccination other than for a child or an emigrant.
Male
Name
Sex
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 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.
*
As amended by G.N. 103 of 1932 [19.2.23].
† As amended by Law Rev. Ord., 1939, Supp. Sched.