MEDICAL FITNESS CERTIFICATE

(To be submitted at the time of Educational cum Industrial Tour/

Industrial Visit/Study Tours/Field Visit/Excursion Activity/or any other visit)

I certify that I have carefully examined Mr/Ms ____________________________________

Son/Daughter of Shri/Smt* _______________________________________ whose signature is given
below. Based on the examinations, I certify that he/she has no physical ailments which may interfere with
him/her travelling to another country and including the active outdoor activities.

Visible mark of identification: ________________________________________________________

High altitude requirement, if any:______________________________________________________

Signature of Candidate: ______________________

Place: ______________
Date: ______________
Name & Signature of **
The Medical Officer

with Seal and Registration Number

____
* Strike whichever is not applicable
** To be signed by a Registered Medical Practitioner holding a valid Medical degree.