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1st Part
Medical Check-up Report
Name:………………………..……Present Designation……...........................…
Working Place………………………………………………………...........…….
(Filled By Authorized Medical Officer)
1. Height…………… ….(metre); Weight……….........…. …(kg)
Eye-sight…………………………….…Blood Group…….....…..........…….......
Blood Pressure…………………… ……………………………............……..…
2. Physical Weakness/Type of Disability (If any)…………….............................
……………………………………………………............…...…………………
3. Medical Category............................................................................................
Date………………….
………….....……................
Signature of the Medical Officer
(Seal with Name & Designation)
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Gazette 2021 06

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