Est-95

Signature oI Applicant
Medical CertiIicate Ior non gazetted oIIicers recommended Ior leave or
Extension or commutation oI leave
(Govt. oI India Finance Department no 173-SR Dated 16 March 1931)


I ..........aIter careIul examination oI the case here by certiIy that
........... whose signature is given above is suIIering
Irom................. and I considered that a period oI absence Irom duty Ior
.......... with eIIect Irom........ is absolutely necessary Ior the restoration
oI his health.

Date-----------------

Govt. Medical Attendant
Or
Registered Medical Practitioner (No.)

Medical CertiIicate oI Iitness to return to duty
Signature oI Applicant

I .............. Civil Surgeon oI Registered Medical Practitioner or oI do hereby certiIy
that I have careIully examined........ OI the Department...............
Whose signature is given above and Iind that he has recovered Irom his illness and is now Iit to resume
his studies in Government Service I also certiIy that beIore arriving at this decision I have examined the
original Medical CertiIicates and statements oI the case(or CertiIied copies there oI) on which leave was
grated or extended and have taken these in to consideration in arriving at my decision.
Date----------------------------------

Govt. Medical Attendant
Or
Registered Medical Practitioner (No)