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This can be used when you are signing before a notary. If you are not using a notary, you can delete the portion at the bottom (“Sworn before me…”) Certification of Accuracy I, the undersigned, [name of translator and degree], being duly sworn, depose and say that [describe your credentials here, eg. I hold a doctorate in French language and literature], that I am fluent in both the English and the French languages, and that I certify that the attached English translation, of the [describe document, eg., birth certificate / marriage license] of [name], from the annexed document in the French language, is a true and complete translation to the best of my knowledge, ability and belief. . _______________________________ Translator Sworn before me this day, . exp. Notary Public State of Wisconsin NAME MERKA, Stanislav No. SECOND YEAR, FIRST STAGE YEAR 1971-1972 Session: June 1972 No. 2012 GRADES WRITTEN EXAMS Biophysics Biochemistry Histology-Embryology Physiology Anatomy Psychology Social Science & Economy 26/40 25/40 20.5/40 21.75/60 42.5/60 8.75/20 TOTAL 144.50/260 RESULT PASSED PRACTICAL EXAMS Social Science & Economy Biophysics Chemistry Histology-Embryology Physiology Anatomy FINAL RESULT 20/20 13/20 11/20 17/20 17/20 PASSED Mr. MERKA, Stanislav FIRST YEAR, SECOND STAGE YEAR 1972-1973 WRITTEN EXAMS SESSION 1 No. 3039 SESSION 2 No. 3005 22 22 21 11 11 11.5 3 8 26.5 18 25 16.5 5 18 10 14 TOTAL (out of 420) 109.5 133 RESULT REFERRED PASSED 6 4 1 53.5 35 16 54 36.75 16 TOTAL (out of 20) 105 106.75 RESULT REFERRED PASSED BIO-CLINICAL INSTRUCTION Bacteriology Anatomy Pharmacology Hemobiology Genetics Parasitology Experimental Medicine General Radio. coef. 2.5 2 2 1.5 1.5 1 1 1 PATHOLOGY Medical Semiology Surgical Semiology Emergency Medicine coef. TUTORIALS Bacteriology Hemobiology Pathological Anatomy Pharmacology Parasitology Clinical Apprenticeship (of 20) (of 20) (of 20) (of 20) (of 20) (of 20) 1ST Semester 2nd Semester FINAL RESULT 18.5 14 14 10 17 16 16 REFERRED REFFERED Mr. MERKA, Stanislav No. YEAR 1973-1974 FIRST YEAR, SECOND STAGE SESSION 1 No. 3085 WRITTEN EXAMS BASIC SCIENCE Bacteriology-Virology-Immunology Pathological Anatomy Pharmacology Hemobiology General Genetics General Parasitology Experimental Medicine General Radio. 16.5/50 16.5/40 22/40 19/30 8/20 17/20 10/20 11/20 TOTAL (out of 420) 120/240 RESULT PASSED PATHOLOGY Medical Semiology Surgical Semiology Emergency Medicine 70/120 38/80 17/20 TOTAL 125/220 RESULT PASSED PRACTICAL EXAMS Bacteriology Hemobiology Pathological Anatomy Pharmacology Parasitology Clinical Apprenticeship FINAL RESULT 10 15 PASSED INTO SECOND YEAR, SECOND STAGE LAST NAME FIRST NAME MERKA Stanislav SECOND YEAR, SECOND STAGE (1st year, 2nd part of 2nd stage) YEAR 1974-1975 SESSION 1 No. 4059 GRADE WRITTEN EXAMS Pleuropulmonary Endocrinology Diseases of the Digestive Tract Medicine Surgery (of 60) (of 60) 31 PASSED 30 PASSED (of 40) (of 20) 12 11.75 16.75 9.5 23.75 REFERRED 26 REFERRED TOTAL (of 60) General Surgery, Traumatology & Surgical Specializations Gen, Sur, -Traumatology Otorhinolarynology Opthamology Stomatology (of 60) (of 10) (of 10) (of 10) (of 60) (of 30) (of 15) (of 15) TOTAL (of 60) Hospital Apprenticeship Gynecology-Obstetrics FINAL RESULT GRANTED GRANTED (of 60) TOTAL (of 60) Infectious Diseases, Parasitic Disease & Dermatology Infectious Disease Parasitic Disease Dermatology SESSION 2 No. 4020 GRADE (of 20) 10.5 7.5 6 6.5 30.5 PASSED GRANTED 16.5 6 6.5 12 7.5 10.5 26 REFERRED 30 PASSED 18 – 18 – 18 29 REFERRED 35 PASSED REFERRED PASSED w/a certificate to be validated LAST NAME FIRST NAME MERKA Stanislav THIRD YEAR, SECOND STAGE (2nd year, 2nd part of 2nd stage) YEAR 1975-1976 WRITTEN EXAMS Cardio-Vascular Diseases Infantile Diseases Nephrology & Urology Blood Diseases & Cancer Neurology, Neurosurgery (of 60) (of 60) (of 60) (of 60) (of 60) HOSPITAL OFFICES (of 20) 1st Quadrimester 2nd Quadrimester 3rd Quadrimester SESSION 1 June 1976 No. 5014 SESSION 2 September No. 5035 GRADE GRADE 30.5 PASSED 36 PASSED 25 REFERRED 19 REFERRED 26 REFERRED GRANTED GRANTED 36 PASSED ABSENT 15 REFERRED REFERRED PASSED w/ 2 certificates to be validated 8.75 REFERRED 30.75 PASSED 17 19 18 FINAL RESULT 2nd YEAR, 2nd STAGE Diseases of the Digestive Tract LAST NAME FIRST NAME MERKA Stanislav FOURTH YEAR, SECOND STAGE (3rd year, 2nd part of 2nd stage) YEAR 1976-1977 YEAR 1977-1978 Session 1 No. 6054 Session 2 No. 6027 Session 1 No. GRADE GRADE GRADE (of 40) (of 20) 21 7 27 10 (of 60) 28 REFERRED 37 PASSED (of 60) (of 20) (of 20) (of 20) 10 11.5 10.75 (of 60) 32.25 PASSED GRANTED (of 60) 37 PASSED GRANTED 5 REFERRED 31.5 PASSED 25.5 REFERRED WRITTEN EXAMS Rumatology & Orthopedics Rumatology Orthopedics TOTAL Social, Preventative Medicine, Medical Economy Forensic Medicine Industrial Medicine Hygiene TOTAL Psychiatry & Medical Psycho. 3rd Year 2nd Stage Blood Disease-Cancer Neurology PRACTICAL EXAMS Forensic Medicine Industrial Medicine Hygiene OPTIONAL CERTIFICATES (of 20) (of 20) (of 20) 33.00 PASSED