Certificate of Physical Fitness by a Single Medical Officer

CERTIFICATE OF PHYSICAL FITNESS BY A SINGLE MEDICAL OFFICER THE CIVIL MEDICAL BOARD SIGNATURE OF CANDIDATE: ………………………………………………………………………………….. I

/

We

do

hereby

certify

that

I

/

We

have

examined

Thiru

/Thirumathi

/Selvan

/Selvi

……………….………………………………………………………………………………….………………………………………………………………………….. a

Candidate for employment under the Government / Private as ……………………………………………………………………….. In the ………………………………………………………………………………. Department and signature is given above and cannot discovered that he/she has any disease, communicable or otherwise, constitutional affiliation or bodily infirmity/ except that his/her weight is in excess or / below the standard prescribed, or except.

I/We do not consider this a disqualification for the employment he/she seeks. His / Her age is according to his/ her own statement years ……………………………………………………………………………………………………………. years.

and

by

appearance

about

I/ We also certify that he/ she has marks of small –pox / vaccination: ………………………………………………………………….. CHEST MEASUREMENT IN

:

On full inspiration ………………. Cms. Weight in Kg

On full expiration ………………. Cms.

…………………………………………

Cardio Vascular System ………………………………………… His/ Her vision

Difference (Expansion) ………………. Cms.

Height in cms

….………………………………………….

Respiratory System

……………………………………………..

………………………………………………………..

Hypermetropic/ myopic/

…………………………………………………………………………………….. Astigmatic/

(Here enter the degree of defect and the strength of connection glasses) (Hearing is Normal, defective (Much / Slight))

………………………………………….

URINE : Albumen

…………………………………………

ii) Sugar

……………………………………………..

State Specific gravity PERSONAL MARKS: 1. 2. Station : Date

:

Signature