Medical Form
Medical Form
Medical Form
PART-A
PART-B
Certificate by Government servant (or member of his family in case of deceased Government servant):
Certified that:
i. The member(s) of my family for whose treatment reimbursement has been claimed is wholly
dependent upon me.
ii. The claim was not drawn before.
iii. I shall have no objection to the recovery of any amount overpaid, if any from my pay/pension
or otherwise.
Signature
NAJAM UL HASSAN SHAH
___________________________________________
(IN BLOCK LETTERS)
Date:
Signature
Designation
Dated: ________ Official Stamp
COUNTERSIGNATURES
1 08
CPO Waqar Javed
2 08
SPO Saleem Elahi
3 08
SPO Malik Ahmed Khan
4 05
SPO Haroon Wazir
5 05
APO Rafi Ullah
6 06
JPO Ahmed Mujtaba
Signature:
________________________________________________________
Full Name of the Government Servant