CERTIFICATE OF MEDICAL FITNESS

I, do hereby certify that I have examined

Shri./Smt.......................................................…………....................
employment/admission in.................................................... and cannot discover that
he/she has any disease, constitutional affection or bodily infirmity
except.................................................................. I do not consider this a disqualification
for employment/admission in................................................. His/Her age according to
his/her own statement is............. years and by appearance about.......... years.

I further certify that................................................... bears marks of successful

vaccination and that he/she is revaccinated now.

Height :
Weight :
Chest Normal :
Expanded :
Contracted :
Eye sight :
Distant Vision :
Near Vision :
Personal marks of identification:
1.
2.

Place :
Date :
Medical Officer.

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