It is certified that Mr/Miss___________________________ S/ D/O _________________________________ is suffering from
______________________________. It is certified that his/her disability is a permanent disability. It is further certified that his/ her
disability puts him/ her at disadvantage as compared to a normal person for acquiring education before entering Medical/
Dental College, but otherwise he/she is capable of performing his/her duties satisfactorily as a Medical Practitioner. It is further
certified that his/ her disability is not of such a severe degree that makes him/her unable to acquire medical education or work as
doctor. Moreover I certify that at present he/she is mentally fit and physically able to carry on studies and perform professional
duties after qualifying MBBS/BDS.
(Full Signature)
(To be signed by certified specialist in the relevant field in the Govt. hospitals).
Name of the Consultant __________________________________________________________
Designation ___________________________________________________________________
Specialty ____________________________________________________________________
Qualification __________________________________________________________________
Present Place of Posting _________________________________________________________
Official Stamp bearing name, Designation and Place of Duty
Date________________________
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