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Get Socioeconomic Information Form

Hereby authorize (name of nominated physician) to provide the airlines with the information required by those airlines medical departments for the purpose of determining my fitness for carriage by air and in consideration thereof. I hereby relieve that physician of his/her professional duty of confidentiality in respect of such information, and agree to meet such physician s fees in connection therewith. I take note that, if accepted for carriage my journey will be subject to the general.

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