1890_MEDICAL_REGISTRATION_ORDINANCE__1884 — Page 6

1790

I, A.B., residing at

ORDINANCE No. 6 OF 1884.

Medical Registration.

C

Form B.

do hereby

declare, that I am a member (or as the case may be) of (here state the college, faculty, or society) and was authorised by such (here state the college, faculty, or society which gave the authority) on the

day of

18 , to practise medicine and surgery, and that I am by the name of A. B., duly registered in the United Kingdom under the provisions of the Act 21 and 22 Victoria, chapter 90, as qualified to practise medicine and surgery.

Signed

A. B.

Declared before me this

day of

18

C.D., Justice of the Peace.

Form C.

I, A.B., Colonial Secretary, do hereby certify that C.D. has satisfied me that he is a medical practitioner, registered as such, and entitled to practise medicine and surgery in (name of Colony), and I give this certificate accordingly under section 12 of the Medical Ordinance, 1884.

Dated this

day of

18

A. B., Colonial Secretary.

Form D.

We, the medical board, do hereby certify that A.B. has satisfied us that he is a medical practitioner, holding a diploma (or as the case may be) (granted to him by as the case may be) in consequence of his having passed through a course of study and examinations as thorough and sufficient as is the minimum course in such a case approved by Her Majesty's Most Honourable Privy Council under section 21 of the Act of Parliament 21 and 22 Victoria, chapter 90, and we give this certificate accord- ingly under section 13 of the Medical Ordinance, 1884.

Dated this

day of

18

(To be signed by a majority of the Board).