Please Confirm.
You have not suffered from
and not taking medication for

Malaria (within 1 year)
Hepatitis B, C *
Any other type of Jaundice (within 5 years)
AIDS
Tuberculosis (within 2 years)
Diabetes (are you under medication currently?)
Fits/ Convulsions (are you under medication currently?)
Cancer *
Leprosy or any other infectious diseases
Any allergies (Only if you are suffering from severe symptoms)
Hemophilia/ Bleeding problems *
Kidney disease *
Heart disease *
Chicken Pox (within 1 year)
Hormonal disorders *
Hemoglobin deficiency / Anemia (recently)
Drastic weight loss (recently)
Small Pox Vaccination (within the last 3weeks)
Blood Donation (within the last 3 months)
Blood Transfusion (within the last 6 months)
Major Surgery (within the last 3 months)
Pregnancy (within the last 6 months)
Organ Transplant (within one year)