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Affidavit of loss id sample

Aid 1420 62-2025

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The document is a USAID Contractor Employee Physical Examination Form, which collects essential medical information to assess the physical ability of individuals for overseas assignments. It includes sections for personal details, medical history, family health background, and specific health conditions. The form emphasizes the importance of accurate information for determining eligibility for employment under USAID contracts and access to embassy health services. Additionally, it outlines the responsibilities of both the examinee and examining physician in completing and reviewing the medical examination.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal details in Section 1, including your name, contract number, date of birth, and place of birth. Ensure all information is accurate.
In Section 7, provide your mailing address in the U.S., and in Section 8, enter the name and address of your contractor along with their contact information.
Complete Section 12 regarding family history. If any relatives have chronic diseases, specify their relation and health status.
Answer all questions in Sections 13 to 21 thoroughly. Each 'Yes' response must be explained in the provided space.
Finally, review all sections for completeness before signing at the end of the form. Use our platform's features to save and share your completed document easily.

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Versions	Form popularity	Fillable & printable
2003	4.9 Satisfied (56 Votes)
1996	4.4 Satisfied (409 Votes)

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