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LONDON PORT HEALTH AUTHORITY.
Public Health (Ships) Regulations, 1952.
(Complete in BLOCK letters).
I and the following members of my family
are proceeding to the following address forthwith:-
No. or Name of House
Street (1)
Town and Postal District
County
Signature
Date
For use of Medical Officer:
Previous Vaccinations (dates) or Scars
Last Vaccination (Validity of Certificate)
Read Carefully and Retain
Public Health (Ships) Regulations, 1952.
SMALLPOX PRECAUTIONS.
1. In accordance with the above Regulations you are permitted to disembark under
surveillance (medical supervision) on the following conditions :—
(a) That you give to the Medical Officer of Health of the Port of London the precise
address to which you are proceeding immediately on landing.
(b) That if you change your address at any time within 14 days of disembarkation you (2)
shall notify forthwith your new address to the Medical Officer of Health of the
Port of London on the attached card.
2. When you leave the ship, keep the bottom portion in case you change the address given
by you on the top portion within fourteen days.
3. If you change your address or do not go to the address given on the top portion,
plete the lower card and post it at once.
4. If you feel ill within the next fourteen days, report to a doctor at once.
PENALTY for Breach of the Regulations, £100.
LONDON PORT HEALTH AUTHORITY.
Public Health (Ships) Regulations, 1952.
NOTIFICATION OF CHANGE OF ADDRESS WITHIN 14 DAYS OF DISEMBARKATION.
(Complete in BLOCK letters).
Having disembarked from the s.s
on (date) my address from (date)
to (date) will be as under. (3)
Name
No. or Name of House
Street
Town and Postal District
County
Signature
This card may be sent through the post unstamped but if it is enclosed in an Envelope
Postage must be Prepaid.
No Postage
Stamp
Postage necessary if
will be posted in
Paid by Great Britain
Licensee or Reverse
Northern of (3)
Ireland
Business Reply Card
Licence No
THE MEDICAL OFFICER OF HEALTH,
PORT OF LONDON,
5, CHURCH PASSAGE,
LONDON, E.C.2.
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