721, pregnancy statement for air travel

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PREGNANCY STATEMENT FOR AIR TRAVEL
Finnair
Medical Clearance
Fax: +358 9 818 4825
E-mail: [email protected]
A pregnancy statement is required after 28 weeks of
pregnancy.
TO BE FILLED IN BY PHYSICIAN
Name of passenger
Date of birth
Place of treatment
Weeks of pregnancy
Due date
Normal pregnancy, no restrictions for air travel.
Risk pregnancy, air travel is not recommended.
Place and date
Signature, name in block letters, title
TO BE FILLED IN BY PASSENGER
Outbound flight (route, flight number, date)
Finnair 721 10/11
Inbound flight (route, flight number, date)
Passenger’s contact information (telephone number or e-mail address)
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Finnair Plc, Helsinki, Finland
Business ID: 0108023-3
Address: Tietotie 11 A, 01530 Vantaa, Finland