Est.95 Signature of Applicant
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Medical certificate for nongazetted officer/official recommended for leave or extension or Commutation of leave (Govt. of India, Finance Department No.173 S.R. dated 16th March, 1931 ) I __________________________________________ after careful examination of the case hereby certify that _____________________________ whose signature is given above is suffering from ________________________ and I consider that a period of absence from duty of _____________________ with effect from ______________ is absolutely necessary for the restoration of his health. Dated
: ________ Government Medical Attendant or Registered Practitioner (No. )
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Est.95 Medical certificate of fitness to return to duty for nongazetted officer/official (Govt. of India, Finance Department No.173 S.R. dated 16th March, 1931 ) Signature of Applicant
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I, __________________________________________ Civil Surgeon / Registered Medical Practitioner of ____________________________________________ do hereby certify that I have carefully examined ____________________________________________________ of the Department ________________________________ whose Signature is given above and find that he has recovered from his illness and is now fit to resume his duties in Government Service I also certify that before arriving at this decision I have examined the original Medical Certificate and statements of the case (or certified copies there of) on which leave was granted or extended and have taken these into consideration in arriving at my decision. Dated
: ________ Government Medical Attendant
or Registered Practitioner (No. )