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  • Sterilization Certificate Format

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    sciencewing rbi
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    This document is a sterilization certificate for a vasectomy operation. It certifies that a semen count was performed on a given date and that based on the results, the vasectomy operation was completely successful. It requires the signature of the certifying authority. It also includes an undertaking from a government employee that they or their spouse has undergone sterilization (vasectomy or tubectomy) and that if recanalization is required in the future, they will report it to the government immediately. It also certifies that the employee's wife is not currently pregnant.

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    This document is a sterilization certificate for a vasectomy operation. It certifies that a semen count was performed on a given date and that based on the results, the vasectomy operation was completely successful. It requires the signature of the certifying authority. It also includes an undertaking from a government employee that they or their spouse has undergone sterilization (vasectomy or tubectomy) and that if recanalization is required in the future, they will report it to the government immediately. It also certifies that the employee's wife is not currently pregnant.

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    © All Rights Reserved
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    5K views1 page

    Sterilization Certificate Format

    Uploaded by

    sciencewing rbi
    This document is a sterilization certificate for a vasectomy operation. It certifies that a semen count was performed on a given date and that based on the results, the vasectomy operation was completely successful. It requires the signature of the certifying authority. It also includes an undertaking from a government employee that they or their spouse has undergone sterilization (vasectomy or tubectomy) and that if recanalization is required in the future, they will report it to the government immediately. It also certifies that the employee's wife is not currently pregnant.

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    of 1

    3

    ForEr No. I
    STERILISATION CERTITICATE

    2. A spem countwasundertaken on .....................................


    and
    on the basisthereofit is certified that rhe Vase.tomyOperationhas
    t€en completelysuccessful.

    @ara2 in the case.ofVas€ctomyopemtionsonly)


    * Deletewolds whete not applicable.

    Signatule

    Form No. II
    (NDERTAKING TO BE GIVEN BY ALL GOI'ERNMENT
    EMPLOYEES
    VMy spousehave/hasundergoneVasectomy/Tubectomy
    OPeratron at .......On ..................-.,.........
    Necessarysterilisationcertiftcateissuedby -...._-...-.................
    ls
    enclosed.In caseVmy spousehaveto take r€Eortto recanalisationfor
    any reasonwhatsoeverI undertaketo report this fact forthwith to the
    Govemment.
    2. I alsocenjb'tharmy wife Smr......._..........-.........-...........
    is
    not pregnanton this date.
    (Para2 for maleCovemmentemployeesonly)

    Kiran Raghupathi Vice President KSPSTA

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