Certificate of Physical Fitness by Medical Officer

Signature of Candidate

I do hereby certify that I have examined

..........,
Paste photograph here
a candidate for employment in the ...

..

Department and cannot discover that he/she has any disease,

constitutional affection or bodily infirmity except .

Photo attested
.

I do not consider this as a disqualification for employment in

the Office of .

His/her age according to his/her own statement is

... years and by appearance about .

years. He/she has a small pox/ vaccination mark.

Personal marks of identification

Thumb Impression attested

1)

2)

Signature of Medical Officer:

Name : Office Round Seal
Reg No. :
Rank :
Designation :
Station :
Date :