Quarantine Station, Ministry of Health, Labour and Welfare ...

1 Quarantine Station, Ministry of Health, Labour and Welfare , Government of Japan Certificat de test COVID-19 Certificate of Testing for COVID-19 Date de d livrance Date of issue Nom Date de naissance Name Date of Birth Ce document certifie que les r sultats suivants ont t confirm s par un test de la COVID-19 par chantillon pr lev sur la personne susmentionn e. This is to certify the following results which have been confirmed by testing for COVID-19 conducted with the sample taken from the above-mentioned person.

2 Echantillon Sample Cochez l une des cases ci-dessous / Check one of the boxes below M thode de test COVID-19 Testing Method for COVID-19 Cochez l une des cases ci-dessous / Check one of the boxes below R sultat Result Date et heure de collecte d chantillon Specimen Collection Date and Time Remarques Remarks Pr l vement nasopharyng Nasopharyngeal Swab Pr l vement nasal Nasal Swab Salive Saliva Pr l vement nasopharyng et oropharyng Nasopharyngeal and oropharyngeal swabs Test d amplification des acides nucl iques NAAT: PCR, LAMP, TMA, TRC, Smart Amp, NEAR, S quen age de nouvelle g n ration Nucleic acid amplification test NAAT: PCR, LAMP, TMA, TRC, Smart Amp, NEAR, Next generation sequence Test antig nique quantitatif (CLEIA/ECLIA) *1 Quantitative antigen test (CLEIA/ECLIA) Negatif Negative Positif Positive Interdiction d entr e sur le territoire japonais No entry into Japan Date (aaaa/mm/jj) Date (yyyy /mm /dd) / / Heure Time AM/PM : *1 Pas de test antig nique qualitatif.

3 Not a qualitative antigen test. *2 Le pr l vement nasal est valable lorsque la m thode de test est le test d'amplification de l'acide nucl ique. Nasal Swab is valid when the test method is Nucleic acid amplification test. Nom de l institution m dicale Name of Medical institution French Quarantine Station, Ministry of Health, Labour and Welfare , Government of Japan Certificat de test COVID-19 Certificate of Testing for COVID-19 Date de d livrance Date of issue Nom Date de naissance Name Date of Birth Ce document certifie que les r sultats suivants ont t confirm s par un test de la COVID-19 par chantillon pr lev sur la personne susmentionn e.

4 This is to certify the following results which have been confirmed by testing for COVID-19 conducted with the sample taken from the above-mentioned person. Echantillon Sample Cochez l une des cases ci-dessous / Check one of the boxes below M thode de test COVID-19 Testing Method for COVID-19 Cochez l une des cases ci-dessous / Check one of the boxes below R sultat Result Date et heure de collecte d chantillon Specimen Collection Date and Time Remarques Remarks Pr l vement nasopharyng Nasopharyngeal Swab Pr l vement nasal Nasal Swab Salive Saliva Pr l vement nasopharyng et oropharyng Nasopharyngeal and oropharyngeal swabs Test d amplification des acides nucl iques NAAT.

5 PCR, LAMP, TMA, TRC, Smart Amp, NEAR, S quen age de nouvelle g n ration Nucleic acid amplification test NAAT: PCR, LAMP, TMA, TRC, Smart Amp, NEAR, Next generation sequence Test antig nique quantitatif (CLEIA/ECLIA) *1 Quantitative antigen test (CLEIA/ECLIA) Negatif Negative Positif Positive Interdiction d entr e sur le territoire japonais No entry into Japan Date (aaaa/mm/jj) Date (yyyy /mm /dd) 2022/ 6 / 1 Heure Time AM/PM : *1 Pas de test antig nique qualitatif. Not a qualitative antigen test. *2 Le pr l vement nasal est valable lorsque la m thode de test est le test d'amplification de l'acide nucl ique.

6 Nasal Swab is valid when the test method is Nucleic acid amplification test. Nom de l institution m dicale Name of Medical institution Sample French