Shri Goutam Biswas, WBCS(Exe.

),
Special Secretary,
Department of Youth Services & Sports,
Government of West Bengal,
New Secretariat Buildings,
s" Floor
Kolkata-700001.

Subject: Prayer for recovery of injury/physical fitness assessment at Sports Medicine Centre,
S.S.K.M Hospital, Kolkata. ~

Sir,

I, son/daughter/wife of .
(Name)
.............................. resident of .
(Address)

................................................................................................a player of .
discipline. currently attached with .
..........Association/Organization. My date of birth is Now, I want to get
recovery of my injury /physical fitness tested at sports Medicine Centre, SSKM Hospital,
Kolkata.

1 shall be highly obliged for the same.

Yours faithfully,
Date:
Time:
(Signature)
Name:
Contact No.:
Documents submitted
1. Photo copy of Aadhhar Card
2. Photo copy of Voter Card
3. Photo copy of Age proof Certificate
4. Photo copy of Medical Report
Recommended by

Signature
President/Secretary
Name:
........................................ Association/Organization
Stamp

'.

Received the application from Shri/Smt .

for the purpose of recovery of injury/physical fitness assessment at SSKM Hospital, Kolkata.

Date:
Time: Signature
'Name

Designation