Medical Fitness Certificate PDF Download
Medical Fitness Certificate PDF Download
CERTIFICATE OF MEDICAL FITNESS
To be obtained only from Gazetted Government Medical Officer / Medical Officer of a Government Undertaking. (Please note that Medical Certificate issued by Private Practitioners will not be accepted)
Name (In Block Letters) …………………………………………………………………………………………………………
Parent / Guardian Name …………………………………………………………………………………………………………
Sex Male /Female Blood Group (Optional) ………………………………
Height ………………………….cm Weight ………………………..kg
Chest: Exp………………………cm Insp.. ………………………….cm
Heart ……………………………. Lungs ……………………….
Vision ………………………….. Hearing ………….. ………..
Hernia / Hydrocele / Varicocele/ Piles, etc: ……………………………………………………………………………….
Any Other Disease Diagnosed in the Past: ………………………………………………………………………………..
Allergies, if any ……………………………………………………………………………………………………………………..
Personal Marks of Identification:
I do hereby certify that I have examined Sri / Kum / Smt………………………………………………………………,
Son / Daughter of………………………………………………………………….., who is an applicant for admission
to B.Tech/ MTech / PhD Program and could not notice that he / she has any disease, constitutional affection, bodily infirmity or mental unsoundness. His / Her age according to his/her statement is
……………………………………………… year and by appearance about ……………………… years.
Signature of the Candidate
Place ……………………………………
Date …………………………………….
Office Seal
Signature: of the Medical Officer
Name: _________________________________
Designation: _______________________________
Registration No. ___________________________
