ect of such information,and agree to meet such physician’s fees in connection therewith.РI take note that,if accepted for carriage, my journey will be subject to the general conditions of carriage/tariffs of the carrier concerned and that the carrier does not assume any special liability exceeding those conditions /tariffs.РI agree to reimburse the carrier upon demand for any special expenditures or costs in connections with my carriage .”Р(where needed ,to be read by /to the passenger, dated and signed by him/her or on his/her behalf.Р为了我旅程顺利成行,我授权(指定的医生姓名)向航空公司医疗部门提供必要的信息资料,同时,考虑到减少医生对信息进行保密的职业责任,我同意支付医生由此产生的费用。我声明,如果能被航空公司接受运输,我遵从航空公司的运输条件以及相关承运人收费标准,航空承运人不承担任何超出的这些条件及收费标准的责任。我同意支付航空承运人为了承运我而产生的任何特殊支出或成本"。(根据需要,请旅客阅读或阅读给旅客听,由他/她或他/她的代表签字,注明日期)РPlace地点:РDate日期:РPassenger’s Signature旅客签名:
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