Medical Certificate Format

. MEDICAL CERTIFICATE OF FITNESS .

I have examined Shri / Kumari / Smt. _____________________________________
Son / Daughter of Sri _______________________________________________ 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 interfere with 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 the 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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