arofte rt 35. (Fate) CA, Form 35 (Revised) eT AeHTE GOVERNMENT OF INDIA aoe fer fear CIVIL AVIATION DEPARTMENT sree) aT a MEDICAL CERTIFICATE 448 sere A ate ‘satis arco FF (t) fe Ree aor et oer mee tare 1m after & corde at ref ey 8 orl wer sada raed wa it eT (8) Bayard when at gal 8 te a agra ealfat B wae A Aaa e Ad HE BAI 1, the undersigned, centify that (D, boom at the domiciled at. has ‘undergone a medical examination for inital issue/renewal of Licence and that he has been found fiVunfivtemporarily unfit o serve in the capacity ofa flight crew member as (2) face starr) ah eR Recommendations of Medical Officer we FRE ar Pa puta PR aR m ‘This report is subject to final assessment by the Director of Medical Services, Air Headquarters, New Delhi. st en, rar gern, 8 fee arr fa err We ante ean Given at she. day of vO eats & wearer Facer eter % eT Signature of person examined Signature of Medical Examiner aris et Office Stamp (1) 0m, Gem, EU em ate ere (3H) TT Name, Surname, Principal name/and Chistian (Sub) names. (2) Sarr ies & aed Foe fe Aaa # PgR eT Indication ofthe capacity in which to be employed as flight crew member. a eat ara ae Sie Teen {Pe ede oe he A Tt BB ore ow AT Ta WE glo aH gE aT A BT or ar rn 8 gs | ‘thereby declare that since the date ofthe above medical examination Thave not ben involved in any aciden, not suffered from an avess oe dst. * » * ate FTE Place Date Sigoature voit sectirtion ge fo fer Safe aaa Sgr A ahaa a sda hee ae we eT Te aC “The candidate should sign the above declaration, f more than 30 days have passed since his medical, examination.