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CJlllk:
Dr. A.K. Gupta Btno2, VIiii■■ Canllll
M.11.JJ.S. New Dtlld-1.llltll
Rescl r,1., Dellll MCl/0997 Ph.: ,a11149174
DMC 1345' Rllldmct :
' (Pt,;ddz:, & Saraeon) CA-J"2, Tqon C,......
Es·R•ld•t Medial Ollcer el N.., Dellil-1 IN2'7
SaldarJu•& Hocpltal

Medical Certificate

No. 129 Datad .2.:5.:.k.-t!.


Signature of Patient ............ ...
I ..•••••• :.!!.~.1~!-...fi.~P~.....................after careful
;z~. . ~~. =c;:J!:J;:~ . =~·~. ·:~·
whose signature Is given above i'S/w~s
suffering from ......... (l)(f-........................... •······
~
: : : ofc~~~. .~.~.~r/.:'~;;~"JJ.
1

with effect from ..


~ ~. ~.~.~~~~~. :::
.J..21..f.... . ... 7:.f if-~
to...

• resto~on of hlr
ls absolutely necessary for the treatment /

heath.

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