Van Der Vijver, Gifford Traill

To be filled in by, or on behalf of, Practitioner on
Service.

INTIMATION FORM

Reference Number: 
SMC/3/4/1/14 1:4
Name of Practitioner (Surname): 
Van Der Vijver
Christian Names in Full: 
Gifford Traill
Address: 
C/P G Lawson Esq, 5 Rosslyn Terrace
City/Town: 
Edinburgh
Rank in Army (or Navy): 
Captain RAMC (Special Reserve)
The above-mentioned Practitioner is on Service as stated
Present Work: 
113th Field Ambulance stationed at Crookham, near Farnham, Hampshire

SPECIAL NOTE:

1. Where a Practitioner holds a Commission, but is still at home, this
Intimation Form should be filled in by the Practitioner himself.

2. Where a Practitioner is absent from home on Service, this Intimation Form
should be filled in by some person on his behalf.

 

To be returned to

The Secretary,

Scottish Medical Service Emergency Committee,

Royal College of Physicians,

Edinburgh.