Anti-Plague Inoculation Certificate.
Na.................................. of 190 . ................................ District.
Name
Father's or
husband's
name
Caste
Sex
Age
State of Health
Residence. (In
large towns note
street or mohalla).
If previously inoculated
date place
and number of
inoculation certiticate
Inoculated this day Date
Place
Date c. c.
Number of brew
Left thumb Mark
Inoculating Medical Officer.
Keep this certificate carefully
and show it when you are
again inoculated.
Salam Press.-Jullandur