8/4/2019 Fitness+and+Unfit+Certificate

1/1

Est.-95

Signature of Applicant _________________________________

Medical certificate for non-gazetted officer/official recommended for

Leave or extension or Commutation of leave

(Govt. of India, Finance Department No.173 S.R. dated 16th March, 1931)

I __________________________________________ after careful

examination of the case hereby certify that _____________________________

whose signature is given above is suffering from ________________________ and I

consider that a period of absence from duty of _____________________ with effect

from ______________ is absolutely necessary for the restoration of his health.

Dated : ________Government Medical Attendant

or Registered Practitioner (No. )____________________________________________________________________

Est.-95

Medical certificate of fitness to return to duty for non-gazetted officer/official

(Govt. of India, Finance Department No.173 S.R. dated 16th

March, 1931)

Signature of Applicant _________________________________

I, __________________________________________ Civil Surgeon /

Registered Medical Practitioner of

____________________________________________ do hereby certify that I have

carefully examined ____________________________________________________of the Department ________________________________ whose Signature is given

above and find that he has recovered from his illness and is now fit to resume his

duties in Government Service I also certify that before arriving at this decision I have

examined the original Medical Certificate and statements of the case (or certified

copies there of) on which leave was granted or extended and have taken these into

consideration in arriving at my decision.

Dated : ________Government Medical AttendantOr Registered Practitioner (No. )