Voluntary sterilisation Act, 193- : [draft] / Joint Committee on Voluntary Sterilisation.
- Date:
- [Between 1930 and 1939]
Licence: Public Domain Mark
Credit: Voluntary sterilisation Act, 193- : [draft] / Joint Committee on Voluntary Sterilisation. Source: Wellcome Collection.
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![14] Give name, I, [ea] fall postal ae : address and of ‘|. . description of hereby declare that the above signature was “made in Witness to tho my presence, this (day) of (month) (year). Signed :—[?*] [15] Signature of witness to the above signature. To the Mumister of Health. N.B.—1. Two medical certificates on Form III are required in support of every application. 2. The marginal notes must be strictly followed, and the inappropriate words or clauses struck out. Form III. CERTIFICATE OF MEDICAL PRACTITIONER IN SUPPORT OF AN APPLICATION FOR STERILISATION, fl 1] Give name of In the matter of [ ] ake proposed : to be sterilised. 2 2] Give full of [ ] : anit address of same. [3] Give descrip- tion (profession an applicant (on his/her own behalf) (through his/her of obputaven) parent or guardian) for permission to be sterilised, . I eal [4] Give name of- 2 . medical certifier. ; [5] Give full of 5 postal address of medical certifier. hereby declare as follows :— . 1. I am a registered medical practitioner (and the ~ usual medical attendant of the above-named [*| ) (and approved by the Minister of Health) (and approved by the Minister of Health as a practitioner experienced in psychological medi- cine), for the purpose of signing certificates under the Voluntary Sterilisation Act, 193 d 2. On [°] | Se at [7] , [7] Give place of examination. I are examined the above-named [*] and am of the opinion that Pere: is a fit and proper person to be sterilised, on the ground that he/she [*] [8] Strike out the paragraphs which do not apply. (a) is suffering from mental defectiveness as defined by the Mental Deficiency Act, 1927;](https://iiif.wellcomecollection.org/image/b3217052x_0013.jp2/full/800%2C/0/default.jpg)
