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Medical Certificate form

Uploaded by

Malu Sakthi
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20 views3 pages

Medical Certificate form

Uploaded by

Malu Sakthi
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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Medical Certificate for Leave or Extension of Leave

Signature of the Applicant:__________________

I, Dr. _______________________ after careful Personal examination of

the case hereby certify that Mr./Miss./Mrs./ ______________________________

__________________________________________________________ whose

signature is given above is suffering from

___________________________________________________ and I consider

that period of absence from duty of ______________________ with effect from

________________ is absolutely necessary for the restoration of his/ her health.

Station :_______________
Dated: ________________
Fitness Certificate

Signature of the Applicant:__________________

I, Dr. _______________________ do hereby certify that I have carefully

examined Mr./Miss./Mrs./ __________________________________________

______________________________________ of ____________________

Department and find that he/she has recovered from his/her illness and is now fit

to resume duties from _______________________________ I also certify that

before arriving at this decision. I have examined the original Medical Certificate

of the case on which leave was granted and have taken these in to consideration

in arriving at my decision.

Station :_______________
Dated: ________________
Maternity Leave Certificate

Signature of the Applicant:_________________

Certified that Mrs._______________________________ Age ________

Years, wife of Thiru._________________________________ has attended the

Out-Patient Department of this Hospital.

She is about __________ weeks pregnant and her expected date of delivery

will be rounded about the _________ weeks of ___________

Station :_______________
Dated: ________________

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