SPECIMEN COPY

MEDICAL CERTIFICATE
I, Dr. case hereby certify that as un!er ". Name of the Patient #. Son$Dau%hter of &. '%e$Sex (. '!!ress after careful personal examination of the hose particulars are

). Date of Issue *. Dia%nosis +. Perio! of rest ,. No. of !ays -in or!s . fi%ures/ 0. Patient1s si%nature -2o be atteste! by the treatin% !octor/

It is absolutely necessary for the restoration of his$her health.

Name . si%nature of the treatin% physician ith stamp 3e%istration number of the Doctor -State Me!ical Council$ Me!ical Council of In!ia/