MEDICAL CERTIFICATE

Rule 103 Part I K.S.R.

(Signature of applicant)

I, (Name)..............................................……………………. after careful

personal examination of the case hereby certify that (Name and official
address)................................. ,.......................................…………….......................
signature is given above, is suffering from..................... ,..........................and
that I consider that a period of absence from duty of..................... with
effect from................... is absolutely necessary for the restoration by
his/her health.

I also certify that the illness or injury was directly due to risk incurred in the
course of his official duties and that the leave recommended is necessary to
effect a cure.

Place :

Date :
Signature of Medical Officer

Registration No.

Part of Registration

System of Medicine

0189