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Pre Employment Medical Declaration Form

The document is a Pre-Employment Medical Declaration Form for Saima Maqbool Shaikh, an Officer in Airport Operations & Customer Services at IndiGo. It includes a declaration of no medical impediments affecting employment and a Medical History Form detailing her current health status, which indicates no significant medical issues. The form requires submission to the Human Resources Department upon completion.

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sksaima1221
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51 views1 page

Pre Employment Medical Declaration Form

The document is a Pre-Employment Medical Declaration Form for Saima Maqbool Shaikh, an Officer in Airport Operations & Customer Services at IndiGo. It includes a declaration of no medical impediments affecting employment and a Medical History Form detailing her current health status, which indicates no significant medical issues. The form requires submission to the Human Resources Department upon completion.

Uploaded by

sksaima1221
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

PRE-EMPLOYMENT MEDICAL DECLARATION FORM

To: Human Resources Department


IndiGo
Employee Declaration and Acknowlegement :
I hereby declare that, to my knowledge and belief, I suffer no medical impediment or disability which
would adversely affect my employment with IndiGo Airlines. I agree to give medical information pertaining
to any illness, personal injury, medical treatment or disability, in the Medical History Form attached below,
and, if required, to the Medical Advisor at IndiGo.
MEDICAL HISTORY FORM
Name : Saima Maqbool Shaikh
IGA Code: 87046
Designation: Officer - AO&CS
Date of Joining:
Department: Airport Operations & Customer Services

Please declare your curren medical condition in the format mentioned below.
Remark/ Details of the medical treatment /
Medical Information Yes/No medication you are taking if answer to any question
is a "Yes"
Any defect in the eye
Yes Corrected by Vision
(including corrected vision/vision)
Hearing problem / Ear Infection / Hearing loss
No
/ any Ear Surgery
Asthma or any form of Lung disease No
Epilepsy / Convulsions No
Recurring Migraine / headaches/ Blackouts or
fainting /loss of consciousness/ problems / back or No
spinal surgery
Diabets / Hypertension No
Tuberculosis No
Any chronic Kidney / Liver disease No
Heart or blood Vessel surgery / any heart disease / No
any history of heart attack
State of Preganancy (currently pregnant or
No
not)
Any Back / Arm / Leg problems following any
No
surgery
Hopitalization /Admission from the date of No
offer till the Date of Joining
History of any form of Cancer No
Use of any psychoactive substance / reaction No
of drug addiction / alcholism
✔ I hereby declare that, to the best of my knowledge, the list of illnesses, personal injuries and medical
treatment and/or disabilities (if any) mentioned above, is a true represnetation of my medical
history. Electronically signed by:
Saima Maqbool Shaikh
Name of the employee Saima Maqbool Shaikh Signature of the employee
Date Location: BOM
Note: Please submit this declaration duly signed in original to the Human Resoures Department, IndiGo

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