MEDICAL FITNESS CERTIFICATE

DATE:
NAME: FATHER NAME:

AGF 26 GATE PASS NO: SEX: ral HEIGHT: S3 wEIGHT:

PERMANENT ADDRESS:

PRESENT ADDRESS:

NAME OF CONTRACTOR WITH WHOM ENGAGED AT

PRESENT: M/S -
Abhilosha
EttaerSeS Bachali
DESCRIPTION OF PRESENT JOB:
DESIGNATION:
IDENTIFICATION MARKS:
abow
PULSE:
BLOOD PRESSURE:
BLOOD GROUP:
EYE VISION:
126/Q ra
EPILEPSY: LIMPING GAIT:
FLAT FOOT: YES/NO MENTAL
DEPRESSION:YES/NO FREQUENT HEADACHE:YES/NO
CHEST MEASUREMENT-INSP:
EXP:
HEIGHT PHOBIA:

HEALTH :GoOD/FAIR/P0OR
REMARKS:

AFTER EXXAMINING MR/MRS

YEAR.
Lalit Jagoe
HE/SHE IS FIT/UNFIT FOR HEIGHT WORK. MEDICAL
FITNESS
IHEREBY GERTIFY THAT
REVIEW BE REPEATED AFTER ONE
TO

Signature
Signatute of the candidate achef
thBestai tantewana
Reg.Nods
(print or stamp examiners name)