(f) A lunatic, an idiot, or a person of unsound mind.
(g) If the same or other facts were observed previous to the time of the examination, the certifier is at liberty to subjoin them in a separate paragraph.
(h) The names and Christian names (if known) of informants to be given, with their addresses and descriptions.
Lunacy, Nos. 8 & 9.
(53 Vict. c. 5, ss. 11, 28, 29, 32 and 33.)
53 Vict. c. 5.—Sched. 2, Form 8.
CERTIFICATE OF MEDICAL PRACTITIONER
In the Matter of ___________________________________
of (a) _____________________________________________
in the (b)________________________ of ________________
(c) ________________________________________________
an alleged lunatic.
I, the undersigned __________________________________
do hereby certify as follows:—
1. I am a person registered under the Medical Act, 1858,
and I am in the actual practice of the medical profession.