(FORM - O)

(See rule 29F(2) and 29L)

Report of medical examination under rule 29-B(To be Issued In Triplicate)

Space for affixing

Passport

Size Photograph

Of the

Candidate

Place:	Signature of examining authority
Date:	Name and designation in block letter:

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* Delete whatever is not applicable

**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.

Report of The Examining Authority