yi 95

Est 96

11 2

MEDICA CERTIFICATE FOR NON GAZETTED OFFICER

LEAVE OR EXTENSION OR RECOMMENDED FOR
(
COMMUTATION LEAVE
4ll, fatfpr qII 173 U3T arttta 16
OF
urd, 19:31)
Govt of lndt Funce departneut No 173
S.R. dated 16th March. 1931)

after careful exaninatio of the case hereby

H s ler that a perod of albsence whose signalure is given above is sullering tron
from duty of
is with
absolulely necessary for the resloration of his health

Dated

Governnent Medical Altendant

or
Registered Practitioner (No

MEDICAL CERTIFICATE OF FITNESS TO RETURN TO DUTY

Siqnatuu Ql Appkail
4

faw

Civil Suqeon of
have carefully do hereby certity tthat | /Reqistetedtnedcal practitionet ol ..
exanined
ricO ' i t n us dlss atid snow it to wBiose siqnalure is qIVen above and lind
that he has
betor s g at tus resume bis dutlies nGoverrnment Service
decsnave xanned ihe original Meical Certificates and Ialso Certity that
tse ed copStteot ) wich leave was q anted or statements of the
01S f ticS arm at y dio exteIded atNd have laken these oto

GovernHnent Medical Allendant

69P tt5/99 2000/0t 21 6 N9 60 000tho
Reqister ed Practitioner (No