Medical Fitness Certificate

Post-Graduate Programme 2017-2019, IIM Bangalore

Name of the Candidate

Test Registration No.

I hereby certify that I have examined Mr./Ms. _____________________________, a candidate

for admission to the Post Graduate Program in Management at the Indian Institute of
Management, Bangalore for PGP 2017-19 Batch.

I cannot discover that he/she has any disease, constitutional affliction or bodily infirmity except
__________________________________. I consider / do not consider the candidate fit for
admission and studies at the Indian Institute of Management, Bangalore.

His/Her age, according to his/her own statement is ____ years and by appearance about ____
years.

Mark(s) of Identification: ______________________________________________

______________________________________________

____________________ ____________________________
(Signature of the Candidate) (Signature of Civil Surgeon/ Asst. Civil
Surgeon/ Medical Officer)

Registration No. ___________________

Seal of Hospital: Date : ____________________
Place: ____________________

Hospital Address: _________________________________________________________