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Transcript of -15 - pdf.drona.in · esod 80ob dCE aJddzdo dOed* mdo etfoo ddud,rod. 04 demo$se oros.oaf.aef.fu....
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CERTIFICATE FOR THE PERSONS WITH DISABITITIES
:Tl""::"**":::1:-:i::' - ;;. ";,;,:;:::::-:;ff::No ""............."'....:....'..' is a case of ...i................ He / She is physically disabled/visual disabled/speech &
hearing disabled and has
visual impairment speech & hearing impairment) in relation of his / her .........
Note:
1. This condition is progressive/non-progressive/likely to improve/not likely to improve. *2. Re-assessment is not recommended/is recommended after a period of ...............months/years.
* Strike out which is not applicable
(Recent AttestedPhotograph showingthe disabilityaffixed here)
sd/-(Doctor)(Seal)
sd/-(Doctor)
(Seal)
sd/-(Doctor)(Seal)
Countersigned by theMedical Su perintendent CMO/Head
of Hospital (with seal)
Signature / Thumb impression
of the disabled person
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permanent / temporary post
(Designation) in the Dept. of ..'......... from
appointed therein under the rules of recruitment.
the said post.
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CERTIFICATE TO BE FURNISHED BY THE STATE / CENTRAL GOW. SERVANTS
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holds a
under the State / Central Govt. as ...........
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Signature of the appointing authority
of the department / with name and seal.