MEDICAL CERTIFICATE

TO WHOMSOEVER IT MAY CONCERN

This is to certify that I have examined

Full Name _________________________________________________________________

Age / Sex ____________ bearing Passport / Voter Card No. ______________________

on (date) ____________________ for the purpose of official visit to Bhutan for work

related to Punatsangchhu-II Hydroelectric Project.

In my opinion, the person examined is in a state of good physical and mental health,

and there is nothing to disqualify him/her on medical grounds for the purpose for

which this certificate is being issued.

Additional comments :

___________________________________________________________________________

Signature of Certifier

Name

Designation

Registration Number

Date (certificate is signed)

Official Seal