medical fitness certificate pdf

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CERTIFICATE OF MEDICAL FITNESS (TO BE DEPOSITED A T THE TIME OF JOINING) To be obtained only from Gazetted Government Medical officer/Medical Officer of a Government Undertaking. (Please note that
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........................................................................................................................................................... Mothers Name : ........................................................................................................................................................... Date of Birth................................................................................................. Signature ............................................................................................................................. Date............................................................................................................. Address............................................................................................................. Name and Address of Father........................................................................................................................ 1 Name........................................................................................................................................................... 2 Name........................................................................................................................................................... 3 Date of Birth................................................................................................. 4 Signature ............................................................................................................................. Address............................................................................................................. 5 Name and Address of Mother........................................................................................................................ 6 Signature ............................................................................................................................. Address............................................................................................................. 7 Signature............................................................................................................................... 8 You must be over 17 years of Age. If you are over 18 years of age you should carry a Valid Driving Licence. Payment to Gazetted Government Official (Please make application in writing within 2 weeks of receiving the Certificate) Name......................................................................................................................................................... Payment to be made to Gazetted Government Official Name......................................................................................................................................................... Name of Party.............................................................. No.............................. ................................................................................................................... Date............................................................................................................. Address............................................................................................................. Name........................................................................................................................................................... Address............................................................................................................. Name........................................................................................................................................................... 9 Payment to be made to Gazetted Government Official (Please make application in writing within 2 weeks of receiving the Certificate) Name......................................................................................................................................................... Payment to be made to Gazetted Government Official Name......................................................................................................................................................... Payment to be made to Gazetted Government Official Name......................................................................................................................................................... (This form is to ensure that you don't use or keep a duplicate.) Please enclose all documents and the prescribed fee of Rs. 50/- (Cash only is accepted.) Payment (Please make application in writing within 2 weeks of receiving the Certificate) Address............................................................................................................. Name........................................................................................................................................................... Date............................................................................................................. Payment to be made to Gazetted Government Official (Please make application in writing within 2 weeks of receiving the Certificate) Payment to be made to Gazetted Government Official Name......................................................................................................................................................... 10 Payment to be made to Gazetted Government Official Name......................................................................................................................................................... 11 You must be over 16 years of Age. If you are over 18 years of Age you should carry a Valid Driving Licence. For each item of Medical Fitness you carry, the medical certificate will be attached as a Copy. Payment to Gazetted Government Offcial (Please make application in writing
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