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Government of Bihar Department of Science and Technology (Govt. Polytechnic Buxar-802123)

Rahulsir pdf physics

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shaduda19
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371 views1 page

Government of Bihar Department of Science and Technology (Govt. Polytechnic Buxar-802123)

Rahulsir pdf physics

Uploaded by

shaduda19
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GOVERNMENT OF BIHAR

DEPARTMENT OF SCIENCE AND TECHNOLOGY


(GOVT. POLYTECHNIC BUXAR- 802123)

FORM FOR MEDICAL EXAMINATION


Space for
(01) Merit Serial No- …………….. Original Category- ………………… Photograph
(02) Name of Candidate- …………………………………………….………. Must be Self
(03) Father’s Name- …………………………………………...……….. Attested
(04) Mother’s Name- …………………………………………...………...
(05) Date Of Birth- Day- ……… Month- ……… Year- ………………
(06) Sex- ……………………………………………………..
(07) Permanent Address- ………………………………………….………………………………….
……………………………………………………………………………..
…………………………................................... Pin Code- ……………….
(08) Correspondence Address-………………………………………….…………………………….
……………………………………………………………………………..
…………………………................................... Pin Code- ……………….
(09) Height (in cm)- :………………………….. Weight (in kg)- ………………………………
(10) Chest- (a) Expanded- ………………..... cm (b) Normal- ………………........ cm
(11) Complexion- ……………………………………………………………………………..
(12) Eye Sight (a) without spectacles- L ………………..…. R ………………..….
(b) with spectacles- L ………………..…. R ………………..….
(13) Two visible marks of identification-
(a)………………………………………………………………………………………………….
(b)………………………………………………………………………………………………….
(14) Weather suffering from any disease/abnormality-
………………………………………………………………………………………………..
(15) Remarks- Sri/Smt./Miss. ………………………………………... has been examined and found
medically FIT/UNFIT

Signature of candidate

In Hindi…………………………………………….

In English…………………………………………..
(Must be done in front of Medical Officer)

Thumb impression of candidate Signature of Medical Officer

Regd. No………………………….

Stamp

(Must be done in front of Medical Officer)

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