Certificate of Physical Fitness by A Single Medical Officer

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CERTIFICATE OF PHYSICAL FITNESS BY A SINGLE MEDICAL OFFICER

I do hereby certify that I have examined (Full Name) . . . . . . . . . . . . . . . . . . . . . . .


Candidate for employment under the Government of Tamilnadu in the . . . . . . . . . . . . . . . . . . . . .
service as . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . and could not discover that he has
any disease, communication or otherwise constitutional affection or bodily infirmity/except
his/her weight is in excess or below the standard prescribed or except.

I do not consider this disqualification for the employment he/she seeks.

His/Her age according to his/her own statement is . . . . . . . . . . . . . . . . .years and by


appearance about . . . . . . . . . . . . . . . . . . . . years.

I also certify that He/She has mark of small pox vaccination.


Chest measurement in Inches/Cms

On full inspiration :
On full expiration :
Difference (expansion) :
Height in Cms :
Weight in Kgs :
His/Her vision all Normal :
Hyporme tropic :
Hyopic :
Astimato (Simple or mixed) :
Urine (Does chemical examination)
(State specify gravity) :

Hearing is Normal / defective


(much of slight) :

Personal marks of Identification*(At least Two should be mentioned)


1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............................................................
2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............................................................

Station :
Date :

Signature :
(With date & Seal)
Rank :
Designation :

NETZONE TIRUPUR 0421 4242073

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