Annexure-6

RAILWAY RECRUITMENT BOARD

Paste here your recent colour

Proforma for Medical Certificate to be obtained from an Eye Specialist by candidates passport size photograph of size
4 cm x 5 cm
applying for the posts of Assistant Station Master/Assistant Loco Pilot/Motorman (The colour photograph
should not be more than
I have checked up Smt./Shri/Kumari*............................................................................ who 3 months old)
The photograph should be
attested
has applied for post of Assistant Station Master/Assistant Loco Pilot/Motorman* in by the Eye Specialist

Railways. Acuity of vision / colour vision of Smt./Shri/Kumari*......................................

.....................................has been tested in view of the following standards required for

Signature of candidate in theabove
appointment on the Railways. box below the photograph

Post Class Distant Vision Near Colour Vision on Ishihara

Vision
Assistant Loco Pilot / A-1 6/6, 6/6 without Sn 0.6/0.6 Normal
Motorman* glasses without
with fogging test glasses
(must NOT accept
+2D)
Assistant Station A-2 6/9, 6/9 without Sn 0.6/0.6 Normal
Master glasses without
(No fogging test) glasses

* Please delete the words which are not applicable.

Smt./Shri/Kumari*............................................................................................................................... fully conforms to

the above vision standards.

Name of the Eye Specialist ............................................................................

Registration No. of the Eye Specialist...............................................................

(Signature of the Eye Specialist)

Place :

Date :
(Seal of the Eye Specialist)