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D

I have examined Shri I Kumari / Smt.


':' 1 '::"::: "1.:::' or viirug. ased
.. P.O,
. ., P.S
Dist..... State . pIN .
/ she is free from deafness, defective vision (including..... . ....... .ro.;*,r, ;;;; ;;
colour
infirmity, mental or physical, likely to interfei-ervith vision) or any other
the efficiency of l.ris 7, her work and
found him / her possessing good health.

This certificate is being given to him


/her for the purpose of

Signature of Candidate

(To be signed in presence of the Medical


Officer)

:. \
Signature of Medical Officer: .

Name of Medical Officer: Dr. ..........

Registration No.

Dated
Seal

Note: Medical certificate granted by a qualifle,j


re :,:at practitioner holding at least
registered rvitn ivledical councii oi i,i.B.B.s. Degree and
Incia, si^*il 66ly be valid. The date
certificate shourd'be within one year of issue of the medical
from the rate or apprication.

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