世界衛生組織規定之國際預防接種證明書格式
International Certificate of
Vaccination or Prophylaxis
International Health Regulations (2005)
Certificat international de
vaccination ou de prophylaxie
Règlement sanitaire international (2005)
Issued to / Délivré à
Passport number or travel document number
Numéro du passeport ou du document de voyage
中華民國衛生福利部疾病管制署
Centers for Disease Control,
Ministry of Health and Welfare,
Republic of China (Taiwan)
國際預防接種/預防措施證明書
INTERNATIONAL CERTIFICATE
OF VACCINATION OR PROPHYLAXIS
持用人
Issued to
INTERNATIONAL CERTIFICATE OF VACCINATION
OR PROPHYLAXIS
This is to certify that [name]
date of birth
nationality
national identification document, if applicable.
whose signature follows
has on the date indicated been vaccinated or received prophylaxis
against (name of doce or condition)
in accordance with the International Health Regulations.
我國現用國際預防接種證明書
Requirements for validity of certificate en page 2.
This is to certify that (name)
date of birth
國際預防接種/
INTERNATIONAL CERTIFICATE OF
This certificats has been issued by the Centers for Dise
CERTIFICAT INTERNATIONAL DE VACCINATION
OU DE PROPHYLAXIE
a été vaccinele) ou a reçu des agents prophylactiques à la date
indiquée contre (nom de la maladie ou de l'affection)
de sexe.
預防措施證明書
VACCINATION OR PROPHYLAXIS
受得人簽名
whose signature follows
has on the date indicated been vaccinated or received
prophylaxis against
(name of disease or condition)
in accordance with the International Health Regulations