Certificate of Physical Fitness by A Single Medical Officer

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CERTIFICATE OF PHYSICAL FITNESS BY A SINGLE MEDICAL OFFICER

1. Name (in Block Letters): ---------------------------------------------------------------

2. Father’s Name: --------------------------------------------------------------------------

3. Age: ----------------------------------------------- years

4. Height: -------------------------------------------- Kg

5. Weight: ------------------------------------------Kg

6. Chest Measurements:

a. On Full Inspiration : ------------------------------Centimeters

b. On Full Expiration :--------------------------------Centimeters

c) Different (Expansion): ---------------------------Centimeters

7. Acuteness of Vision:

a. Right Eye:

b. Left Eye:

8. Color Vision: -----------------------------------------------------------------------------

9. Personal Mark (at least two should be mentioned):

a.

b.

I Certify that I have carefully examined Sri/Smt -------------------------------------------------------------

Son/Daughter of Sri ------------------------------------------------------------------------ Who has signed in my


presence. He/ She has no mental and physical disease and is fit.

------------------------------------------------------------

Signature of the Candidate ---------- -----------------------------------------------

Place: Signature of Medical Officer with legible seal

Date: Registration No: --------------------------------------

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