Annexure VI

Proforma for Medical Certificate to be obtained from an Eye Specialist by

candidates applying for the posts of Station Master/Traffic Assistant.
I have checked up Smt./Shri/Kumari ……..……………………………… Paste self-attested
………………….………..……………….. who has applied for the post of recent passport size
photograph of the
Station Master/Traffic Assistant* in Railways. The acuity of vision/colour
candidate not more
vision of his/her has been tested in view of the following standards than one month old
required for appointment on the Railways.

Signature of candidate
in the above box below the
photograph

Colour vision
Post Class Distant vision Near vision
Ishihara
Station
6/9, 6/9 without glasses Sn 0.6/0.6 without
Master/Traffic A-2 Normal
(No fogging test) glasses
Assistant *

Smt./Shri/ Kumari ...............................................................................................fully conforms to the above vision

standards as applicable for the post of Station Master/Traffic Assistant *.
(* Please delete which is not applicable)

Signature of the Eye Specialist………………………

Place:
Date: Name of the Eye Specialist ………………………….
Registration No. of the Eye Specialist. ……………..

Seal of the Eye Specialist