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    3 views36 pages

    Review Officer

    Uploaded by

    Ashish Yadav

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 36
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Sif the size of the file is more than SOKB then adjust the settings of the scanner such as DPI resolution, no colours etc during the process of scanning, &- The application has to sign in full in the box provided. Since the signature is. Proof of identity, it must be genuine and in full, inttiats are not sufficient. Signature in CAPITAL LETTERS is net permitied. 7. The signature must be signed only by the applicant and nat by any other person, & The signature will be used to put on the HALL TICKET and wherever Necessary, ifthe applicant's signature on answer script at the time of the examination, does not match the signature on the HALL TICKET, the applicant will be disqualified. Sample Image & Signature :- width = 3.8em <> PHOTO 4.5 em Helght=4 Sem Signature ane vipage uftne—2 aan Wear tt again wild cen aqafte anit & fad ona sao sath ear ome te A/a. a/ Pee A edie eee See eT ares Bs Tar 1967 walt /agefae orton @ we F area a eh By a Wise Te & we urna? cer ay fates ant & fed area ) afar, 994 (wereeifia) a appige @ sini ara ora &1 we Howat fen om § & A/a ort... Sere ee enh) 0 aS, a ee ie tn age valet, aaah orranel wea ara Pes at @ fad arent) aha, @qate unite, aqgfta wronftal wer aa fed wild fed arripiataa)) eh wei Page aire, zona eet ehfta ait wh 8, omeortter Te 81 erat areT—Reen at Bree Gh af Fl aah & fd awa alte ara one ore woe aT ga ater aEt & ce eae oer wre aay, 957 ¥ uenitier ae er a sew eeu oh a Br t/a ga gail ead iste too 1. FB We Pra &, foreT Siders ht oewin &, ifs a ad ene af } wee & wit fafa at, nice GE ORGTR H EE aafkes are g.00.00000 (ats ore Te ata) a SNL ps ig es Fi 2 ae 8 i 5 (aie) yay ST TH FR We Ba et wie oer gee afny dorwet or Ete un — cafe seremfore & afeete 400 wef arat array gene) anes aT orenthy years | ve srreaferes TR 200 FF aro gm ga aif wr aera we) A at ant... 2 ver Hann AEE & a STRAPLRT afd, arqyfaa orronftr en ary fee aif aera wet 21 aipare woe meg TE ater Weare z (aa-2) ate or 8 aie of o oral ard theo oF ee cho FA ee ik Saw | ee eek eee bet eae Fo DT a/v CO oe weer Ag se ae at ie ora er es of gt aa 2 Mert gr ad (teehee a) gE cuentas )é 3 Roar toe afeatas oe S Rae sen gad often sry Be aerate Te 81 aT od wart oe fers iterated) at whey wears A ails wr a aerate ot & eR FST / ante) 4 A thm ween /aat € fae ae tae A eet ae at cig] Fears ‘Fretfefixa 4 fat of Star a ater teh B- 5 (oie) vers apf shea fh emer ee BI n- ioe Ty de a eed sh ora ore w= ata eRafter & savin 100 Th Te oe get ale or oranda yrs | & aT WW — arefia aeremferr A gee 200 ef rot arerar ge after wr sere Es | A water on /aradt PS AR ane aula aren AR get ote fra AR we 2 ok 4 onfle oa od ak of S fat orem yen oe ae Sear grey ear ae | ae AY ane dh adh ater areata oh ett a et wa Gen /ored ¢ fh ge onder & oe wa TA a a are Meftrer veer H fee rar wter/ate Sarat et wer A er A are Agia Pree ee 2 nba fea orn seen ge oar TTS OER WR ae a yearzemr ore Ren sare Sal Af afte fear ot we aie ga wR A AR 1s Pret & ai AR fea <6) ore erat ardent ob fed wenwerAh eer “ee | ate: at any aa at aa are @) artew fare BT RTT AT YET AP ae wou feeriat @ fat war oy CERTIFICATE FOR PHYSICALLY HANDICAP OF U.P. NAME AND ADDRESS OF THE INSTITUTE/HOSPITAL Certificate No... ic uisu aay - Date: DISABILITY CERTIFICATE This is certified that Shri sSmt Kur _-Sontwite/deughter of Shi. ~--~idemtification mark(s). disability of following category, A. Locomotor of cerebral palsy: Bit creat tne sul Suffering from permanent (i) BL- Both legs affected but not arma. (i) BA- Both arms affected. (8) Impaired reach 4b) Weakness of grip (ii) BLA. Both legs and both arms affected. (iv) OL- Gne: lag affected (right or left) a) Impaired reach (b) Weakness of grip (c) Ataxic (v) OA- One arm affected {(@) Impaiced reach {b) Weakness of grip (6) Ataxic (vi) BH- Stiff back and hips (cannot sit or stoop) (il) MV/- Muscular weakness and limited physical endurance. 5. Blindness or Low Vision: H|Page Re () B- Blind ) PB- Partially Bind C. Hearing Impairment: 4) D- deat (i) PD- Partially Deat (Delete the category whichever is not applicable) 2. _This condition is progressiveon-pregressiverikaly to improve fnot likely to Improve. Re-assess of this case is not recemmendadlis recommended after a pariod of year, months. 3. Percentage of disability in his / her cage is. percent, 4 Shri/Smb uM. rere meets the following physical ‘requirements discharge of his #her duti () F--can perform work by manipulating with figures. YesiNo (i) PP- can perform work by pulling and pushing YesiNo (ii) Le-can perform work by liting YesiNo (iv) KC- can perform work by kneeling and couching YesiNo (V) Be can perform work by bending YesiNo (vi) &- can pertorm work by siting YesiNo (vil) ST- can perform work by standing Yesio (vil) We can perform work by walking ‘YesiNo (ix) SE- can perform work by seeing YesiNo (0) He can perform work by hearing/speaking Yeo (43) RV can perform work by reading and writing YesiNo Dhrscscand: ( Mem Chairperson Medical Board Medical Board Countersigned by the Medical Superintendent ICMOIHQ. Hospital (with seal) ‘Strike cut which is not applicable, Bove ea Sar Haltat & sabi wf feed wary oa Se wer Ste ar (efits wr a foes, veda GIT Sarita & sabia aie yogd Ves & feed arm) wfiPas, 1903 (veareietfia) & ODER acerca Bart Sate Ah / aah / pNP P/E / t/t Pertee sera afte) sexiftes aR, 1903 (earieha) 3 oat S oar wat AL/ abe Gace Far WPA). 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