1964_TERMINATION_OF_PREGNANCY_REGULATIONS — Page 6

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[Subsidiary]

L.N. 50/82.

CAP. 212] Termination of Pregnancy Regulations

FORM 2A

(*Delete as appropriate)

CONFIDENTIAL

[1982 Ed.

[reg. 3.]

Not to be destroyed within five years of the date of operation

OFFENCES AGAINST THE PERSON ORDINANCE (Chapter 212)

CERTIFICATE TO BE COMPLETED IN RELATION TO THE TERMINATION

OF A PREGNANCY OF MORE THAN 24 WEEKS DURATION UNDER

SECTION 47A(2C) OF THE ORDINANCE

I,

( Name and qualifications of practitioner in block capitals i

of

(Full address of practitioner,

and I,

( Name und qualifications of practitioner in block capitals 1

of

Full wddress of practitioner.

hereby certify that we

are*

were

of the opinion. formed in good faith, that it

was*

is*

necessary to terminate the pregnancy of

( Full name of pregnant woman in black capitals -

of

Usuul place of residence of pregnant woman in block capitals :

(Ring appropriate letter!

in order to save the life of the pregnant woman.

This certificate of opinion is given--

A. before the commencement of the treatment for the termination of the

pregnancy to which it relates;

B.

or, if that is not reasonably practicable, then

not later than 24 hours after such termination.

Signed

Signed

Date

Date