Page:United States Statutes at Large Volume 59 Part 2.djvu/312

 978 TREATIES [59 STAT. International Sanitary Convention, 1944 INTERNATIONAL CERTIFICATE OF IMMUNITY AGAINST YELLOW FEVER THIS IS TO CERTIFY THAT (Age Sex ) whose signature appears below is immune to yellow fever as the result of an attack of the disease. This immunity has been demonstrated by the mouse protection test. Date of bleeding Place of bleeding Name of Laboratory performing test Location of Laboratory Date of Test Result of Test Signature of Laboratory Director Official Stamp of Laboratory (Signature of person tested) (Home address) Footnote: This certificate is not valid: (a) unless the laboratory performing the blood test and the method employed have been approved by UNRRA; (b) for more than ten years from the date of the blood test.

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