Railway Concession Certificate for physically & mentally Disable persons

Appendix 1/45
(See Rule 101, S. No: 25, 28, 29 (1))
Concession certificate for orthopedically Handicapped/paraplegic persons / patient/mentally Retarded person/ Completely
Blind Person/ Totally Deaf and Dumb Person.

This is to certify that Shri/ Smt/ Kumari __________________________________________________________________

Whose particulars are furnished below is bonafied ORTHOPEDICALLY HANDICAPPED / PARAPLEGIC PERSON /
PATIENT/ MENTALLY RETARDED PERSON WHO CANNOT TRAVEL WITHOUT THE ASSISTANCE OF ESCORT
PERSON/ COMPLETELY BLIND PERSON/ TOTALLY DEAF AND DUMB PERSON.

Particulars:
a). Address: ______________________________________________________________________________

b). Fathers/ Husband’s name: _________________________________________________________________

c). Age: __________________________________, d) Sex: ___________________________________________

e). Nature of Handicapped / Disability (to be written by the Doctor whether the disability is temporary or Permanent).

f). Signature or Thumb impression of orthopedically handicapped / paraplegic person / patient: (not necessary for those
whose both hands are missing or non-functional).
________________________________________

Round Seal Containing full name and Hospital

_________________________________
(Signature of Government Doctor)
__________________________
Registration Number of Doctor:
Countersign By Chief Medical officer
** strike out whether not applicable
# For blind person RMP / Head of the institution for the Blind recognized can also issue certificate for Blind.
Note:-
1. This certificate should be issued only to those orthopedically handicapped / paraplegic person/patients who cannot travel
without assistance of escort / mentally retarded/ completely blind person / completely Deaf and Dumb Person. The Photo must
be Signed and stamped in such a way that doctors signature and stamp appears partly on the photo and partly on the
certificate.
2. For mentally retarded person/ completely blind person/ Deaf and Dumb person (Both affictions together), the certificate will be
valid for 5 years from the date of issue. For temporary disability in case of orthopedically / paraplegic persons the certificate
will remain valid for (1) five years, In case of person up-to the age of 25 years (2) ten years, in case of person in the age group
of 26 to 35 years and (3). In case the persons above the age of 35 years the certificate will remain valid for whole life of the
concerned person. After expiry of the period validity of the certificate, the person is required to obtain a fresh certificate.
3. The original certificate will have to produce for inspection at the time of purchase of the concessional ticket and during journey.

4. No alteration in the form is permitted.