SECTION - 3

MEDICAL FITNESS CERTIFICATE

(To be signed by CMO or equivalent Doctor from Govt. / District Hospital)

I certify that I have carefully examined Mr./Ms.…………………………………………………......

Son / Daughter of Mr./Ms.……………………………………………………………………………

whose signature is given below.

Based on the examination, I certify that he/she is in good mental and physical health and is free from
any physical defects which may interfere with his/her studies including the active outdoor duties
required of a professional.

Blood Group………………………………………………………………………………………….

Identification Marks…………………………………………………………………………………..

Signature of the Candidate……………………………………………………………………………

Name of Medical Officer: …………………………………………………...............

Registration Number: …………………………………………………......................

Signature of the Medical Officer: ………………………………….….......................

Place:
Date: SEAL

(Note: To be submitted at the time of joining IIMT, pending which admission will not be confirmed)

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