PHYSICAL FITNESS CERTIFICATE (To be issued by a Registered Medical Practitioner) PERSONAL HISTORY

1. Name of the Candidate 2. Parent¶s Name 3. Age: 25 Years : BODABALLA RAVIKIRAN : B.S.V.Prasad 4. Sex: Male : Nil CERTIFICATE (The following are to be filled by the Medical Officer conducting the medical examination) 1. Height ««««««..cm 3. Past History a) Mental Disease ««««««« b) Epileptic Fit ««« 5. Blood Group «««««««««.. 7. Vision with or without glasses a) Right Eye«««««««««««. b) Left Eye«««««« c) Colour Blindness «««««««« d) Uniocular Vision «...... 8. Respiratory system ««««««« 10. Heart a) Sounds««««««««««. b) Murmur ««««««. . . . . 12. a) Hernia «««««««««. b) Hydrocele «««««««« 13. Any other defects««««...«««««««««««««««««««««.. Certified that«««««««««««««««««««««««««««««««... Son of ««««...««««««««««««««««««««««««« is in sound physical health to pursue his studies at ANDHRA UNIVERSITY COLLEGE OF ENGINEERING 9. Nervous system ««« 11. Abdomen a) Liver««««««.. b) Spleen «««««.. 2. Weight ««««. kg 4. Chest a) Inspiration «««cm b) Expiration «««.cm 6. Hearing«««««....

5. Identification Mark on the Body : Mole below left ear 6. Major illness/ surgery, if any

Signature of the Medical Officer Date..«««««««««««««. Full Name.«««««««««........ Medical Registration No. and Official Seal ««««

Signature of the candid ate

Major illness/ surgery. Nervous system ««« 11.. Full Name. Age: 52 years : M. Name 2. Blood Group «««««««««.cm 3... Any other defects««««. Abdomen a) Liver««««««. Heart a) Sounds««««««««««.. 7.. 2... b) Hydrocele «««««««« 13. Parent¶s Name 3.cm 6. 5. Vision with or without glasses a) Right Eye«««««««««««. Respiratory system ««««««« 10. if any Signature of the Medical Officer Date. Hearing«««««..V.. Sex: Male : Nil CERTIFICATE (The following are to be filled by the Medical Officer conducting the medical examination) 1. . Certified that«««««««««««««««««««««««««««««««. Past History a) Mental Disease ««««««« b) Epileptic Fit ««« 5.. b) Left Eye«««««« c) Colour Blindness «««««««« d) Uniocular Vision «.... . b) Murmur ««««««.. kg 4.. b) Spleen «««««. Identification Mark on the Body: Mole on chin 6. Son of ««««. .V.... 8.««««««««««««««««««««««««« is in sound physical health to pursue his studies at ANDHRA UNIVERSITY COLLEGE OF ENGINEERING 9.. .«««««««««««««..T.«««««««««... and Official Seal «««« Signature of the candidate .. Medical Registration No.. Weight ««««. a) Hernia «««««««««.SATYANARAYANA : Apparao 4.. Height ««««««.«««««««««««««««««««««. 12. Chest a) Inspiration «««cm b) Expiration «««...PHYSICAL FITNESS CERTIFICATE (To be issued by a Registered Medical Practitioner) PERSONAL HISTORY 1.

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