|
醫(yī)療機(jī)関における検査証明書の添付なきものは無効 如沒有附上醫(yī)療機(jī)構(gòu)交付的證明原件,申報(bào)無效 Those without original certification issued from a medical institute are invalid |
||
|
検査申告書／ 檢查申報(bào)書 ／ Declaration of pre- - entry testing |
||
| 氏名/姓名/Name | 英文/English | |
| 和文or 中文 | ||
| パスポート番號(hào)/護(hù)照號(hào)碼/Passport No. | ||
| 國(guó)籍/Nationality | ||
| 生年月日/Date of Birth | ||
| 性別/Gender |
□男/Male □女/Female |
|
| 採取検體/樣本類型/Sample |
□鼻咽頭ぬぐい液/鼻咽拭子 Nasopharyngeal Swab □唾液/Salvia |
|
| 検査法/ /Testing for COVID-19 |
□核酸増幅検査（RT-PCR 法） nucleic acid amplification test □核酸増幅検査（LAMP 法） nucleic acid amplification test □抗原定量検査 quantitative antigen test (CLEIA) |
|
| 検査結(jié)果/ Result | 陰性 / 陰性 / Negative | |
| 決定年月日/采樣結(jié)果確定時(shí)間/Result Date |
2021/ / |
|
|
検體採取日時(shí)/采樣時(shí)間 Sampling Date and Time |
2021/ / |
|
| 交付年月日/ Date of issue |
2021/ / |
|
| 醫(yī)療期間名/醫(yī)療機(jī)構(gòu)名稱/Medical institution | ||
|
醫(yī)療機(jī)関住所/醫(yī)療機(jī)構(gòu)地址/ Address of the institution |
||
|
上記記載及び別添の検査証明書のとおり、中華人民共和國(guó)の認(rèn)可された醫(yī)療機(jī)関において-19の陰性証明を受けたうまい申告します。 如上述記載及附件的檢查證明所示，特此申報(bào)本人已取得中華人民共和國(guó)認(rèn)可的醫(yī)療機(jī)構(gòu)簽發(fā)的 COVID-19 陰性檢查證明。 As indicated above and in the attached test certificate, I declare that I have received a negative test result of COVID-19 from an authorized medical institution in the People's Republic of China. |
||
|
記入年月日/填表日期/Date of Declaration: 2021/ / 署名 Signature: |
||
