MEDICAL FITNESS CERTIFICATE

DATE:- O2162823
NAME: Can dan kumart FATHER NAME: Kaykumen
GATE PASS NO: SEX: Ce' HEIGHT: S'sl WEIGHT: Go
AGE2
PERMANENT ADDRESS:
vi-tocangaj
Hcnala Dld
PRESENT ADDRESS:
Casanthwa f hankhand
mankat Bacheli
NAME OF CONTRACTOR WITHWHOM ENGAGED ATPRESENT: M/S- bhilo eha,

Bntes R°s esBachell

DESCRIPTION OF PRESENT JO8:
DESIGNATION:
Labown
IDENTIFICATION MARKS:
PULSE: BLOOD PRESSURE:
BLOODGROUP:42/min EYE VISION:

EPILEPSY: LIMPING GAIT:

FLAT FOOT: YES/NO MENTAL DEPRESSION:YES/NO FREQUENT HEADACHE:YES/NO

CHEST MEASUREMENT-INSP: EXP:

HEIGHT PHOBIA:
NO
HEALTH :GOoD/FAIR/POOR
REMARKS:

AFTER EXAMINING MR/MRS clardan kumat IHEREBY GERTIFY THAT

HE/SHE IS FIT/UNFIT FORHEIGHT WORK. MEDICAL FITNESS REVIEW TOBE REPEATED AFTERONE
YEAR.

Signature of Exara
Chandea.
Signaturebtthe candidate Mgdicai
"RegNeSea
(print oSamp examiner's name