ANNEXURE -1

Ref. No.

New Delhi, Dated:

HOSPITALS COPY
DOP&TS COPY
CANDIDATES COPY

ATTENDANCE SLIP
In Triplicate
(To be filled by the candidate)

Name of the Hospital___________________________________________________________

Date_______ ______ and Time_________________________________________________
Name of the Candidate _ ______________________________________________________
Roll No. ____ ______________________________________________________________

(To be filled by the hospital)

This is to certify that Ms. / Mr.______ ____________________________________________
_______________________________Roll No.____________ _________________________
a candidate of Civil Services (Main) Examination,2016 has been medically examined in this

Hospital and after completion of all requisite medical tests, he / she has been relieved

on_____________.

(Signature of the Chairman or his/her

Representative of the Central Standing Medical Board with SEAL)
 -I

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____________________________________________________________

_____________________________ _______________________________

__________________________________________________________

__________________________________________________________________

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() , 2016
/_____________________________________________________________________
__________________
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