MEDICAL CERTIFICATE
1. Name of the candidate : ………………………………………………..
for appointment (in Block letter)
2. Caste or Race : ………………………………………………..
3. Residence : ………………………………………………..
4. Father’s name & Address : ………………………………………………..
………………………………………….…….
………………………………………………..
5. Date of Birth in Christian era : ………………………………………………..
6. Exact height by measurement : ………………………………………………..
7. Personal marks of identification : ………………………………………………..
8. Signature of the candidate : ………………………………………………..
I do hereby certify that I have examined Shri/Smt/Kum ………………… ……………….
a candidate for employment in Navodaya Vidyalaya Samiti and cannot discover that he/she
has any disease communicable or otherwise, constitutional affliction or bodily infirmity except
…………………………………………………………………………………………
I do not consider this a disqualification for employment in Navodaya Vidyalaya Samiti.
His/her age is according to his/her own statement ……………… and he/she appears about
…………………. years.
Left hand thumb and finger impression of the candidate.
Signature of the candidate : ………………………………………………..……
Taken before me : ……………………………………………………..
Name of the Officer : ……………………………………………………..
Designation of the Officer : ……………………………………………………….
(This officer should be Civil Surgeon or Medical Officer or equal rank ………………………………
on (date) ……………………………..)
Signature of the Medical Officer
Seal
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