<div class="modal fade" id="form_genaration_0" role="dialog" aria-hidden="true">

	<div class="modal-dialog" id="modal-dialog1">

		<div class="modal-content">



			<div class="modal-header">


				<button type="button" class="close" id="form_close" data-dismiss="modal" aria-label="Close">

					<span aria-hidden="true">&times;</span>

				</button>

			</div>



			<div id="pdfModal">

				<form class="form" id="form_0_pdf" name="form_0_pdf" method="post" target="_blank">

					<div class="panel-body" id="form_0_pdf_body">









						<div style="margin-top: -20px">



							<div style="margin-top: 10px;">

								<table width="100%" class="tbl3" id="form_header">


									<tr>
										<td colspan="2" align="center"><strong>(FORM - O)</strong></td>
									</tr>


									<tr>
										<td colspan="2" align="center"><b>(See rule 29F(2) and 29L)</b></td>
									</tr>


									<tr>

										<td colspan="2" align="center"><b>Report of medical examination under rule 29-B(To be Issued In Triplicate)</b></td>

									</tr>








								</table>







							</div>



							<div style="margin-top: 10px; ">
								<input type="hidden" name="checkup_id_O" id="checkup_id_O"><input type="hidden" name="form_type_O" id="form_type_O">

								<table width="100%" class="tbl3" id="table_body_form_o">





									<tr>

										<td>
											<!-- <p contenteditable="true">(a)* is medically fit for any
												employment in mines</p> -->
										</td>



									</tr>



									<!-- <tr>

										<td>
											<p contenteditable="true">(b)* is suffering
												from.............................and medically unfit for</p>



										</td>

									</tr> -->



									<!-- <tr>

										<td>
											<p contenteditable="true">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(i) any employment in mines; or</p>


										</td>

									</tr> -->







									<!-- <tr>

										<td>
											<p contenteditable="true">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(ii)any employment below ground
												; or</p>
										</td>



									</tr> -->





									<!-- <tr>

										<td>
											<p contenteditable="true">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(iii) any employment or
												work..............................</p>
										</td>



									</tr> -->






									<!-- <tr>

										<td>
											<p contenteditable="true">(c)* is suffering
												from....................and should get this disability
												cured/controlled and should be again examined within a
												period of....................Months. He will appear for
												reexamination with the result of test of
												.................and the option of............specialist
												from.........He may be permitted/not permitted to carry on
												his duties during this period.</p>
										</td>




									</tr> -->









								</table>




								<table class="tbl3" width="100%">
									<tr>
										<td>Space for affixing</td>
									</tr>
									<tr>
										<td>Passport</td>
									</tr>
									<tr>
										<td>Size Photograph</td>
									</tr>
									<tr>
										<td>Of the</td>
									</tr>
									<tr>
										<td>Candidate</td>
									</tr>

								</table>






								<table width="100%" class="tbl3">


									<tr>
										<td colspan="3" align="right"><span class="profile-picture" id="profile-picture1"> </span></td>
									</tr>

									<tr>
										<td align="left">Place:</span></td>
										<td colspan="3" align="right">Signature of examining authority</td>

									</tr>



									<tr>



										<td align="left">Date: </td>
										<td colspan="3" align="right">Name and designation in block letter:</td>


									</tr>

								</table>

								<table width="100%" style="margin-right: 20px">
									<tr>
										<td width="70%">
											------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
										</td>
									</tr>
								</table>



								<table width="100%" id="id_table" class="tbl3">



									<tr>
										<td align="left">* Delete whatever is not applicable</td>
									</tr>

									<tr>
										<td>
											**One copy of the certificate shall be handed over to the person concerned and another copy shall be send to the manager of the mine concerned by registered post; and the third copy shall be retained by the examining authority.
										</td>
									</tr>

									<tr>
										<td align="center">Report of The Examining Authority</td>
									</tr>

									<!-- <tr>
										<td align="center">
											<p>(To be filled in for every medical examination wherever initial or periodical or re-examination or after cure/control of disability)</p>
										</td>
									</tr> -->




								</table>










							</div>

						</div>

					</div>

				</form>

			</div>



			<div class="modal-footer">

				<div class="form-group">







					<button type="button" class="btn btn-default" onclick="form_generation_for_pdf($('#form_type_O').val())">

						<span class="glyphicon glyphicon-floppy-save">Open PDF</span>

					</button>



				</div>

			</div>

















		</div>



		<form id="form_pdf" name="form_pdf" target="_blank" action="" method="POST">

			<input type="hidden" name="htmlText" id="htmlText" />

		</form>