XURE ‘D-2? [See Rule 4(3) (ii) & (iiiy]* COMPANION REQUIREMENT CERTIFICATE (CRC) is (Applicable for family members/a Certificate No. Sl lependent relatives eligible for pass) | ' | . ails : veal Of This is to certify that I have carefully examined whei/Smit. scr. 2320: ' ‘agp teen aa, Kum. vVRAV KeATIVAR holding Certificate cf Disab iy No. 747. dated 2 6/7/ > >\fose photograph is affixed above and found that helshe. cannot travel without the assistance of a Companion. Helse is ___ Sow __ (indicate relationship i.e. spouse/son/daughter, etc.) of Shri/Suit Kim, SANJAY ertAR KAT YAR seWvinglservedas_ DE / MCE ‘ (designation & Railway). OR This is to certify that I have carefully examined —Shri/Smt/ +, holding Certificate of Disability No, dated , hose photograph is affixed above and found that he/she cannot travel without the assistance of a Companion and is also fully wheel chair dependent for his/her mobility. He/she is of Shri/Smt/Kum. Kum, (indicate relationship i.e. spouse/son/danghter, etc.) serving/served as (designation & Railway). 2. This Certificate is valid for lifetime (in case of permanent disability). . OR ‘YE This Certificate is valid upto_> (in case of temporary disability). Date:_ 2G 2! ‘St. Divisional Medical Officer ‘Modem Coach Factory, Raebareli Note: , agra te feen ear, oer @ This Certificate should be issued only by a Medical Officer not below the rank of Divisional Medical Officer in a Railway Hospital. (i) The portions not applicable should be scored out. * Rule 4(3)(i) of Railway Servants (Pass) Rules: passes specified in clauses (i), (jv) & (y) of sub-rule (1) are tobe issued only in favour of ented faily member(sdependent relative(s) who isfare PwD, a ‘Companion’ may be included on submission of CRC ofthe person in whose favour the pas sto be fssued, a prescribed inthe format at Annexure ‘D.2". No other adult family member/dependent relative shall be included in such asses, However, Minor children fas defined in item 3avil)() under General Rules of Schedul-tl] may be included in such passes. “Rule (ti) of ‘Railway Servants (Pass) Rules: Only one *Companion’ will be permited even if more than one PwD is included inthe Pass. However, in ease of whee! chaired ‘PwD(s), individual Companion to cach wheel-chsired PwD shall be pemnitted. +