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‘FORM No.30
(Prescribed under Rule 100)
Counterfoil........... S.No.....................
Date :-------------- Date :--------------
Certificate of Fitness for Dangerous operations
............................................... .........................................................................
(L.T.I OF Person Examined). ( L.T.I. of Person Examined)
.
Sig. of Certifying Surgeon ------------- ------- Sig. of Certifying Surgeon--------------------------