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MEDICAL CERTIFICATE

MEDICAL CERTIFICATE OF FITNESS


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. ...................................................................

Dated: 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.

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