{"text":"\/MEDICAL EXAMINATION AUTHORISATION SHEET \nB 1 INCTRICD [FB1O \nin conn\u00e9ction with my claim arising out of an accicent on the ( 1] & ,C,_)_,\ufb01f \n| confirm that] agree to being medxcally examined Dy: \n| Name: ml@@(_hd@\u00bbp\\ \n.................................. & mconfs el AQDC\u00abC \nTelephone No: QL. B3 SIS \n| also give my authority for alt medical notes relating to this incident teing released to Direct \n\u2018Line's appointed specialist. \n\u2018(Please Print) . CLL[\/Z\/C@ \/' \/Z\/L\ufb02f T. { \no \nDlreet Line insutanca orc, Jirect ne House, 4~ 18 Cadagan Sbeat, Qlisgow G2 JON, Registares in Engiang Mo 1810801, Aegislensa CHce: ) Edndge Rana. Croyasn CAY 14G. \n_\u2014.____.______ _\u2018 S \nAdvdress Cm\\l@@\ufb01b }\\JLL@CL\\C_ HC'IDPL*\u2018 ' \nSigned \/\u2018\/ M\/\/V\/\u2018 o Datev ?\/:\u2019L\/C\u00e9* . \no \nMST 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