CHEEMA BOILERS LIMITED

SCO 523-524, SECTOR 70, MOHALI, CHANDIGARH

FORM OF MEDICAL CERTIFICATE

(To be signed by registered Practitioner holding a Degree not below MBBS)

(TO BE SUBMITTED AT THE TIME OF JOINING)

I certify that I have carefully examined Mr/Ms ---------------------------------------------------

son/daughter/wife of Mr. ---------------------------------------------------------------------------- whose

signature is given below as a result of his/her examination. I certify that nothing which may

disqualify him/her from joining to a job. I have further report that:

1. His/Her eyes appear to be __________________________________________

2. His/Her heart & lungs are clear ______________________________________

3. His/Her chest measurement is normal ____________ expanded ____________

4. His/Her weight is _________________________________________________

5. His/Her height is _________________________________________________

6. He/She wears glass/does not wear glass _________________ vision and report on

color blindness.

7. He/She has no disease, mental and bodily infirmity which makes him/her unfit the near
future for an active life and job.

8. His/Her Blood Group _________________

9. Chest X-Ray Report.

10. Marks of Identification ______________________

Signature of the Candidate __________________

Dated : ________

Name & Signature ____________________________________

of the Medical Officer

Registration No. _____________________________