SICKNESS CERTIFICATE

This is to certify that Mr./Ms/Miss______________ age about _____ years ___ S/o/D/o/W/o
Mr./Mrs. ____________________________residence of Vill.____________________________
P/s___________ Distt.________________ State_______________ .

He/she is suffering from _________________________________________________. He/she is

under my treatment from __________. He/she is advised for rest for_____________
days/weeks/months.

His/her attested specimen Signature/Thumb impression is below.

Stamp & Signature

FITNESS CERTIFICATE

This is to certify that Mr./Ms/Miss______________ age about _____ years ___ S/o/D/o/W/o
Mr./Mrs. ____________________________residence of Vill.____________________________
P/s___________ Distt.________________ State_______________ .

He/she was suffering from _________________________________________________. He/she was

under my treatment from __________ to _________. Now he/she is medically fit for his/her job.
His/her attested specimen Signature/Thumb impression is below.

Stamp & Signature