MEDICAL CERTIFICATE OF FITNESS

TO WHOM IT MAY CONCERN


DATE :


I have examined Shri / Kumari / Smt _____________ Son / Daughter of Shri _____________ aged _____________ Years, of Village: _____________ P.O. _____________ P.S _____________ Dist _____________ State _____________ PIN _____________ and certify that, he / she is free from deafness, defective vision (including colour vision) or any other infirmity, mental or physical, likely to interferewith the efficiency of his / her work and found him / her possessing good health.


This certificate is being given to him /her for the purpose of _____________


Signature of Candidate
(To be signed in presence of the Medical Officer)




Signature of Medical Officer : ________________
Name of Medical Officer: Dr ________________
Registration No: ________________
Deted :
Seal :



Note: Medical certificate granted by a qualified medical practitioner holding at least M.B.B.S. Degree and registered with Medical Council of India, shall only be valid. The date of issue of the medical certificate should be within one year from the date of application.