Medical Certificate format for engineering students
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MEDICAL FITNESS CERTIFICATE FOR STUDENTS It is certified that I have carefully examined Mr./Ms./Mrs. _______________________________ S/o D/o W/o ________________________________________. 1. His/Her health measurements are: a) Height ______________________ cms. b) Weight ______________________ kgm 2. Vision Test: a) Normal Eyesight L _______________ R__________________ b) With Glass L _______________R__________________ 3. Blood Test: Blood Group_____________________ 4. Age ________________ He/She has no infectious disease or mental or bodily infirmity unfitting or likely to unfit his/her in the future for active outdoor service or proves harmful for campus (Kenway College of I find him/her fit to take part in all activities of college. 5. Special Remarks (if any): ______________________________________________________________________________ ______________________________________________________________________________ Marks of identification: ______________________________________________________________________________ ______________________________________________________________________________ Thumb Impression: Date: ________________ Signature of Candidate (Signature of Gazetted Medical Officer) Signature of Parents/Guardian OFFICE SEAL Please paste a recent passport size photograph environment.
description
Students who need medical leave can use this application form to apply.
Transcript of Medical Certificate format for engineering students
MEDICAL FITNESS CERTIFICATE FOR STUDENTS
It is certified that I have carefully examined Mr./Ms./Mrs. _______________________________
S/o D/o W/o ________________________________________.
1. His/Her health measurements are:
a) Height ______________________ cms.
b) Weight ______________________ kgm
2. Vision Test:
a) Normal Eyesight L _______________ R__________________
b) With Glass L _______________R__________________
3. Blood Test:
Blood Group_____________________
4. Age ________________
He/She has no infectious disease or mental or bodily infirmity unfitting or likely to unfit his/her
in the future for active outdoor service or proves harmful for campus (Kenway College of
Education, ABH.) environment.
I find him/her fit to take part in all activities of college.
5. Special Remarks (if any):
______________________________________________________________________________
______________________________________________________________________________
Marks of identification: ______________________________________________________________________________
______________________________________________________________________________
Thumb Impression: Date: ________________
Signature of Candidate (Signature of Gazetted Medical Officer) Signature of Parents/Guardian OFFICE SEAL
Please paste a recent
passport size photograph
environment.
