Medical Certificate of Fitness for Duty

TO WHOM IT MAY CONCERN


SERIAL NO. :
DATE :


THIS IS TO CERTIFY THAT MR./MRS./MISS : Age Years IS/WAS UNDER MY TREATMENT SINCE
To FOR



HE/SHE IS/WAS ADVISED TREATMENT AND REST FOR THIS PERIOD

HE/SHE IS MEDICALLY FIT FOR RESUME HIS/HER DUTIES FROM





(SIGNATURE OF PT.)
(SIGNATURE OF DOCTOR)