*FORM OF MEDICAL CERTIFICATE
I have this day, medically examined Sri/Smt.
/Kumari………………….
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and found that he/she has no disease or infirmity which would render him/her unsuitable...
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*FORM OF MEDICAL CERTIFICATE
I have this day, medically examined Sri/Smt.
/Kumari………………….
.
.
.
.
.
.
.
.
.
.
.
.
.
.
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.
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and found that he/she has no disease or infirmity which would render him/her unsuitable for
Government Service.
His/her age, according to his/her own statement is ……………………………and
by appearance is ………………………….
.
and his/her standards of vision are as follows:
STANDARDS OF VISION
(Eye Sight without glasses)
Right Eye Left Eye
1.
Disitant Vision:- ……….
snellen ………….
.
snellen
2.
Near Vision: ………….
snellen ………….
.
snellen
3.
Field of vision ;- ……………………….
;.
(Specify whether full or not.
Entry such as ‘Normal
’, ‘Good ‘etc.
will be inappropriate here.
)
4.
Colour blindness:- …………………….
5.
Squint:- ……………………………….
.
6.
Any morbid conditions of the eye of lids of either eye:
He/she is physically fit for the post of ………………………… ………………………….
in
……………………………….
Department.
Signature:
Place
Name and Design ation
Date
of the Me
Less
