BGBl. II - Ausgegeben am 17. Mai 2021 - Nr. 222 1 of 1 Appendix D Medical certificate This is to certify that Name............................................................................................................................................................... born on................................................................in................................................................................... tested negative for SARS-CoV-2 on................................ (date on which test was carried out) at........................................ (time at which test was carried out): by means of a molecular biological test (test carried out at the following clinic: . ..........................................................................................................................) or by means of an antigen test, or has recovered from being infected with SARS-CoV-2 and been free of the most recent case of infection since................................; or was vaccinated with the vaccine..................on the following dates: First dose on: ……………………………………………………………………. Second dose on: ………………………………………………………………….. .............................., on.............................. place, date, signature and stamp of the certifying medical doctor www.ris.bka.gv.at Unterzeichner serialNumber=932783133,CN=Bundeskanzleramt,C=AT Datum/Zeit 2021-05-17T22:52:25+02:00 Prüfinformation Informationen zur Prüfung des elektronischen Siegels bzw. der elektronischen Signatur finden Sie unter: https://www.signaturpruefung.gv.at Informationen zur Prüfung des Ausdrucks finden Sie unter: https://www.bundeskanzleramt.gv.at/verifizierung Hinweis Dieses Dokument wurde amtssigniert.