TRM2
- Document type
- Other
- Dated
- Category
- Documents & Forms
Form of certificate to be issued by a medical practitioner
(Note A to Item XI of Annexure I to Chapter 8)
Form of certificate to be issued by a medical practitioner
nominated by Indian mission etc. abroad
MEDICAL CERTIFICATE
(Name - Block Letters)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
(address)
and he/she is suffering from____________________________________________________________________
_____________________________________________________________________________________________
(ailment).
I recommend that he/she undergoes immediate medical treatment for which he/she will be required to stay for about_______________days in_________________________________________________________
(Name of the country)
The cost of the medical treatment will be approximately ___________________________________
| Place:.................. Date:................... | _________________________________ (Signature of Medical practitioner) |
Name_________________________________
Designation____________________________
Registration No.________________________
Address_______________________________
_____________________________________
_____________________________________