1980 Ed.]
Medical Clinics (Forms) Regulations
[CAP. 343
A 3
[Subsidiary]
Particulars of person registered in respect of the above clinic-
Name (In English)
(In Chinese)
Address
Note: Registration of the above-named person in respect of the above-named clinic and the grant of the exemption hereby certified is subject to the conditions respectively specified (here indicate where conditions are specified, e.g. overleaf, or in the annexure hereto marked or as the case may be).
Dated this day of 19.........
Registrar of Clinics