Concession Ccrtificatefor Personswith Disabilities(Divyangian)

icate form for orthopaedically handicapped/paraplegic person/patients/

person person withvisual impairment with total absence of sight/ person with
impairment totally(bot afilictions together in the same person)

V.R.K.MURY IY
sd No.57 250 MStho)
S1STSURAEON Otho)
RURA ao are furnished below is a
P . h o V e l hose particulars
A..ATSAStö ciy
bonafideORTHOPAEDICALLY HANDIAPPED/ PARAPLEGic PERSON/ PATIENTS WHO
CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN BSCORT / MENTALLY RETARDED
PERSON WHO CANNOT TRAVEL wITHOUT AN ESCORT/ PERSON WITH VISUAL
MPAIREMENT WITH TOTAL ABSENCE OF SIGHT/ PERSON WITH HEARING AND SPEECH
IMPAIRMBNT TOTALLY (BOTH AFFLICTIONS TOGETHBR IN THE SAME PERSON*

Particulars
a Address: HNo 5-y_q, 16od, Amaloqunan
b) Father's/Husband's Name:_
cAge:
d) Sex: MalL
e) Nature of Handicap: (To be written by doctor whether the
disability is temporary or permanent).
) Signature or thumb impression Anaaqla eeeidea
Pemannt,
ofthe person seeking concession (not nçcessary for thoge wjth
So1. D'Nog
both hands, missing or non-functional): _

(Signature of Government Doctor#)

Plago Aeyss Dr. V.R.K.MURTHY
Dafeso SPIo21 e egd.No. 57250 MS(Orthc)
SFVIL ASSISTANT SURGEON
(Ortho
REA HOSPtTA
Clear seedof Governaent Hospital4 Seal Containingfull hame ahd
Registration Number of the Doctor#
Strike out where not applicable.
#For PERSON WITH VISUAL IMPAIREMENT WITH TOTAL ABSENCE OF
SIGIHT,
RMP/Head of institution for the blind recognized can also issue certificate for visual
impairment(with total absence of sight).

1) The certificate should be issuedonly to those ORTHOPAEDICALLY HANDICAPPED/ PARAPLBOIC

PERSONI PATIENTS WHO CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORT
MENTALLY RETARDED PERSON WHO CANNOT TRAVEL WITHOUT AN EscORT/ PBRSON WITH
VISUAL IMPAIREMENT WITH TOTAL ABSENCE OF SIGHT/PERSON WTH HEARING AND SPEECH
IMPAIRMENT TOTALLY (BOTH AFFLICTIONS TOGETHER). The photo must be signed and stamped in such
a way that doctor's signature and stamp appears partly on the photo and partly on the certificate.
2) For mentally retardod person/ PERSON WITH VISUAL IMPAIREMENT WITH TOTAL ABsENCh OP
SIGHT PERSON WITH HEARING AND SPEECH IMPAIRMENT TOTALLLY (BOTH AFFLICTIONS
TOGETHER), tho certificate will be valid for five yoars from the date of issue. For temporary disability in the case
of orthopaedicaly/ paraplegic porsons, the certificate will be valid for 5 years and in case of permanent disability,
the certificato will remain validfor (i) five years,in case of persons upto the age of 25 years, (2) ten years, in case of
persons inthe age group of 26 to 35 years and (3) in case of peraons above the age of 35 years, the certificate will
remain valid for whole life of the conconed persons. After expiry of the period of validity of the certificate, the
person is required to obtain a fresh certificate.
3) Photocopy of this cortificate is accepted for the purpose of graunt of concession. The original certificate will have
to be produced for inspoction at tho time of purchase of concessional ticket and during the journey, if demanded.
4) No alternation in the form is permitted.

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