MEDICAL CERTIFICATE

of suitability and fitness for the purpose of Stipendium Hungaricum Scholarship Programme

I the undersigned Doctor in Medicine, (Full name) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Certify that I examined the blood test results and tests of the below patient:

Full Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nationality:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date of Birth:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Place of Birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Country of Residence: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I have found him in good general health, and free of:

HIV

Hepatitis A

Hepatitis B

Hepatitis C

Any Serious physical / mental illness

Any other epidemic disease

Comment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Date: . . . . . . . . . . . . . . . . . . .����� . . Doctor’s signature and stamp