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Attestation médicale / Medical Certificate / Certificado médico Nom du patient / name of the patient / nombre y appelido del paciente : ____________________________________________________________________________ né(e) le / date of birth / nacido el: ____________________________________________________________________________ domicilié(e) à / place of residence / residente en : ____________________________________________________________________________ A qui de droit: Il est certifié que le voyageur susmentionné a été pourvu des médicaments ci-après pour son usage personnel uniquement. Ils n’ont aucune valeur commerciale. To whom it may concern : This is to certify that the above traveller has been supplied with this medication for personal use only. It has no commercial value. Para efectos del interesado: Esta es para certificar que al viajero nombrado más arriba, se le ha suministrado con estes medicamentos para uso personal solamente. No tiene valor comercial. Contenu / contents / contada: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Date / date / fecha ______________________________ Signature et timbre du médecin traitant Signature and stamp of the treating physician Firma y sello del médico que lo atiende _______________________________
