Saharsa College of Engineering, Saharsa

Govt. of Bihar-852201

MEDICAL CERTIFICATE

1. Name of the Candidate : ……………………………………..……………………..

2. Father’s Name : …………………………….……………………………..
3. BCECE/UGEAC/College Roll No. : ……………………………….……………….
4. Date of Birth : …………………………….……………………………...
5. Marks of identification : ……………………………..……………………………..
6. Chest : (a) Normal : …………….……… (b) Expended : ……..……….……
7. Height : ……………………….…….……………………………..
8. Weight : ……………………………………………………………..
9. Heartbeat : ……………………………………………………………..
10. Vision (a) Without Glass : (a) Rt……………..……… (b) Lt ……………………..
(b)With Glass : (a) Rt……………………. (b) Lt …...………………….
11. Eye Disease if any : …...………………………………………………………
12. Colour Blindness : ……………………………………………………………
13. Fit / Unfit for admission in B.Tech. Programme : ...……………………...……….
Signature of the Candidate (in Hindi) :
(in English) :
Left thumb impression. :

Signature
Registered Medical Practitioner
Registration No. : ………………………