Medical Certificate

Migrant workers/ pilgrims/ tourists/ students/ other persons no

1 to ____ in the application of shri./sau___________________
have been screened by a registered medical practitioner for
Covid-19. All of them are found to be asymptomatic. It is certified
that none of them is having any sign and symptoms of Covid-19.
(fewer, cough etc)

Date- / /2020

Place- ____________

Name of persons screened-

1. (Name, Signature, stamp)
2. Registered Medical Practitioner
3. Reg. No.
4.
5.
.
.