PHYSICAL FITNESS CERTIFICATE

I hereby certify that I have examined Sri/Smt/Kum____________________________

S/o D/o W/o ________________________________ Age _________ R/o _________________________

A candidate for further Studies / Employment / Driving Licenses not suffering

from any disease (communicable or otherwise), constitutional weakness or
physical or mental infirmity. The age according to his / her statement is ______yrs
and by appearance is about ________yrs.

Have marks of successful vaccination.

Identification Marks: 1 _____________________________________________________

2 _____________________________________________________

1) Height __________cms
2) Weight __________Kgs
3) Measurement of chest :
a) On full inspiration __________cms
b) On full expiration __________ cms
4) Examination of :
a) Liver & Spleen ____________
b) Heart & Lungs ____________
c) Sight _______________________
d) Can recognize all natural colors.

Signature of the candidate

Station: Signature of the

Date : Medical Officer