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II 222 2021 Anlage 4

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BGBl. II - Ausgegeben am 17. Mai 2021 - Nr. 222
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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.
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