Medical Certificate for people travelling from Satara to other Districts/

States

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Ref. No. Date -

This is to certify that the applicants as mentioned in the annexure

attached herewith are residing in Satara District at village/city --------------------,

Taluka --------------------------------. They have been medically examined by me

and not found to be showing any SARI / ILI / Fever / Cough or any other

COVID – 19 like symptoms. They are fit to travel.

(List of other traveler(s) is attached here with)

Time :-
Place :- Registered Medical Practitioner
Registration No.
Seal and sign
Name
Mobile no.

Disclaimer : The information about contact history of the bearer of the

certificate is based on self-declaration and Government of Maharashtra is not
responsible for development of symptom during their travel.
 Annexure

Sr.No. Name Age Remark

Fit / Unfit