1
i.qrr.fi-9s - Est"95 qrr6E',i5. ERrqrt Signatureof lpptican, 'rltl'{{l'Jrl't'ri''llltrtt 't,l'.1{.11i* :rt'{;{l t+-fll car{ a{rJ.{t i?a{l qlr,*dl ,r,r*.r.i,.irlt lirnhu err* zrrl are.lt $ttut rrit ilEDICAL CERTIFICATE FOR NON'GAZETTED OFFICER nECOtrt[tENDED FOR LEAVE OR EXTENSIOFI oR coiIItIUTATIoN oF LEAVE Trrfr TRtD'R, fu fu[rrr s€m lrcgIiqlq iTrftil 16rr6{,1es1y (Govt. of lndia, Finance aepaiment No. 173 s.B. dated l6th March, I gsl t qiq 6{t t u,E.,6 ** ** t m. ffir rf-,t ; *,-, * m X u ynnfr $6 ss qsfr 6} rq* fi orqrq Hs'qlr q{;T ErFrr sq+ ftq r{drfr uraqqE { I 1""""""""""""':""""""".... .' after careful examination of the case hereby certify that """' rr-'-r .... and consider that a period of absence from duty ol ;il;ilffii;;;;ffiffi;,#1""ff:trrom """"""" """"""" is absoruterv frrfrs rrr:firfr frfrnr.fi. snrfl atq ri-froT qcffrfufr'fufmmqt Government Medical Attendant or Begistered Practitioner (No. "......................,,... ) i.r + Irfi *n Efe rm ?ilfr€ qril * frq Effidfr gsur-v* . MEDICAL CERTIFICATE OF FffNESSTO RETUHT,I rO OUrV ql+ffi t'arilen Signature of Applicant qrfrMq / {-qtfil sr+tr ....'.......,.......]*5qrF[f,61iilEffit}..i.... t*T*ffi;*,;fr;;fr,;m$* * :"qI FqrFril $-{?lT E fr w frqd qr qgq} t qEA tt qm Eil€t Fnur-r* eilr sq fff{ril (qwr s{+1 ryFmqfrfr) qiqqilmtfu# sTrqmwgg&qg{frrr$ fi erryqrrdr$G ficerrrjTqqat srnt sdt t qlq fr offi+ skr FIqd q{ qEqr dl I """' .................., Civil Surgeon ol / Registered medicelpraditionerol ......... ............... ....... have carefully do hereby certity that I eiamined ^ ........:...: ..r........... of the recovered from his illness and is now fit !B resume his duties in Government service. I also certify that before arriving at this decision I have examinqd ths original Medical certificates and statements of the case (or certified copies thereof) on which leave ,rqg gnani;d or extended and have taken these into cpnsideration is aniving at my decision. , stqlfr fqfuffi sNrqr srq ffi{ EHilsrfucF ffuvo A^..---^-^ la^J!^^l l!^- r- -r

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i.qrr.fi-9s- Est"95

qrr6E',i5. ERrqrtSignatureof lpptican, 'rltl'{{l'Jrl't'ri''llltrtt 't,l'.1{.11i* :rt'{;{l t+-fll car{ a{rJ.{t i?a{l qlr,*dl ,r,r*.r.i,.irlt

lirnhu err* zrrl are.lt $ttut rritilEDICAL CERTIFICATE FOR NON'GAZETTED OFFICER nECOtrt[tENDED FOR

LEAVE OR EXTENSIOFI oR coiIItIUTATIoN oF LEAVETrrfr TRtD'R, fu fu[rrr s€m lrcgIiqlq iTrftil 16rr6{,1es1y

(Govt. of lndia, Finance aepaiment No. 173 s.B. dated l6th March, I gsl

tqiq 6{t t u,E.,6 ** ** t m. ffir rf-,t ; *,-, * m X

u ynnfr $6 ss qsfr 6}

rq* fi orqrq Hs'qlr q{;T ErFrr sq+ ftq r{drfr uraqqE { I

1""""""""""""':""""""".... .' after careful examination of the case hereby certify that

"""' rr-'-r .... and consider that a period of absence from duty ol

;il;ilffii;;;;ffiffi;,#1""ff:trrom """"""" """"""" is absoruterv

frrfrs rrr:firfr frfrnr.fi.snrfl atq ri-froT qcffrfufr'fufmmqt

Government Medical Attendantor

Begistered Practitioner (No. "......................,,... )

i.r + Irfi *n Efe rm ?ilfr€ qril * frq Effidfr gsur-v*. MEDICAL CERTIFICATE OF FffNESSTO RETUHT,I rO OUrVql+ffi t'arilenSignature of Applicant

qrfrMq / {-qtfil sr+tr

....'.......,.......]*5qrF[f,61iilEffit}..i....t*T*ffi;*,;fr;;fr,;m$* *:"qI FqrFril $-{?lT E fr w frqd qr qgq} t qEA tt qm Eil€t Fnur-r* eilr sq fff{ril (qwr s{+1

ryFmqfrfr) qiqqilmtfu# sTrqmwgg&qg{frrr$ fi erryqrrdr$G ficerrrjTqqat srntsdt t qlq fr offi+ skr FIqd q{ qEqr dl

I """' .................., Civil Surgeon ol / Registeredmedicelpraditionerol ......... ............... ....... have carefully do hereby certity that I eiamined

^ ........:...: ..r........... of the recovered from his illness and is now fit !B resume his duties in Government

service. I also certify that before arriving at this decision I have examinqd ths original Medical certificatesand statements of the case (or certified copies thereof) on which leave ,rqg gnani;d or extended and havetaken these into cpnsideration is aniving at my decision. ,

stqlfr fqfuffisNrqr srq ffi{ EHilsrfucF ffuvo

A^..---^-^ la^J!^^l l!^- r- -r