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APPENDIX B.
Ex-officio exemption certificate.
(See Rule 12.)
Signature.
Under Mufassal Rule 12 (Name and designation *) whose signature
is exhibited in the margin is hereby
exempted from the plague notification
rules. This exemption will also cover the undermentioned members of
his family, subordinates and servants accompanying him:-
Members of the family	Subordinates and servants.	
Name.	Age.	Name.	Age.
Date of issue.			
 Number in Collector's/President's register. 		
Signature of the issuing officer.	
Collector of/President of the Corporation of Madras
NOTE.-(1) This certificate will be in force throughout the Presidency until
revoked by the Collector of/President of the Corporation of Madras who may cancel it without
assigning reasons. Any misuse of it by any person will entail its summary withdrawal.
(2) This certificate will not exempt its holder and the persons specified in it from
liability to have their effects disinfected if they are considered to be infections.
(3) The certificate must be exhibited by the bearer on demand to any officer
authorized under the plague regulations to inspect or issue notifications or examine
the health condition of travellers.
(4) The holder of the certificate is bound to report immediately to the nearest
local authority any case of fever or plague or suspicious sudden illness or any unusual
mortality amongst rats occurring in the house or houses in which he or the persons
mentioned in the certificate resides or reside within one month of the last visit to an
infected area.
* (Here enter the applicant's qualification for exemption.)