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    Încărcat de

    Amit Sati
    201 vizualizări2 pagini
    Candidate's Personal Details please fill in the complete form and sign it. Section 2: Candidate Statement Do you have any congenital defect / abnormality? Yes No. If yes, please provide the details. Section 3: medical Certificate of Fitness please hand over the completed form to your induction coordinator.

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    Candidate's Personal Details please fill in the complete form and sign it. Section 2: Candidate Statement Do you have any congenital defect / abnormality? Yes No. If yes, please provide the details. Section 3: medical Certificate of Fitness please hand over the completed form to your induction coordinator.

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    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    201 vizualizări2 pagini

    Ready To Print

    Încărcat de

    Amit Sati
    Candidate's Personal Details please fill in the complete form and sign it. Section 2: Candidate Statement Do you have any congenital defect / abnormality? Yes No. If yes, please provide the details. Section 3: medical Certificate of Fitness please hand over the completed form to your induction coordinator.

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 2

    PleasehandoverthecompletedformtoyourInductionCoordinator

    MedicalCertificateofFitness

    Section1:CandidatesPersonalDetails

    Pleasefillinthecompletefromandsignit.
    Mr./Mrs./Ms./Miss/DrFirstName:______________________LastName:_____________________
    Gender:MaleFemale

    Dateofbirth(DD/MM/YY)___/___/___

    ContactNo:(M)__________________(R)____________________

    Please affix a
    Passport size
    photo here and
    get it attested by
    your consulting
    doctor

    BloodGroup:______

    Section2:CandidateStatement
    Doyouhaveanycongenitaldefect/abnormality? Yes No.Ifyes,pleaseprovidethedetails

    _________________________________________________________________________________________________________

    Doyouhaveanyphysicaldeformity/handicaporuseanymechanical/physicalassistanceformobility? Yes No.Ifyes,


    pleaseprovidethedetails

    _________________________________________________________________________________________________________

    Haveyouhadanyformofseriousillnessoroperationinthelasttwoyears? Yes No.Ifyes,pleaseprovidethedateand

    detailsofthesurgery

    _________________________________________________________________________________________________________

    Haveyoubeentreatedorhospitalizedforcancer,Tumor,Cystoranyothergrowth?
    Yes No.Ifyes,pleaseprovidethe
    details

    _________________________________________________________________________________________________________

    Hasmedicalgroundsbeenareasonforunemploymentoryounotperformingaspecificroleinthepast?
    Yes No.Ifyes,
    pleaseprovidethedetails

    ________________________________________________________________________________________________________

    Haveyoueverysufferedorsufferingfromanyofthefollowing?

    HighBloodPressure
    Stroke
    Bronchitis
    Obesity
    Diabetes
    Arthritis

    PepticUlcer Drugabuse HeartDisease


    SkinInfection Bowels

    HeartMurmur
    Tuberculosis Epilepsy
    ThyroidAilment Arthritis
    Asthma

    Heartattack
    Slippeddisc Liverdisease

    Haveyoueversufferedorsufferingfromanyotherillnessorimpairmentnotmentionedabove?
    Yes No.Ifyes,please

    providethedetails

    Areyoupresentlyinamedicalconditionthatmayrequireyoutobeawayfromworkinthenext12months? Yes No.Ifyes,

    pleaseprovidethedetails

    BloodSpitting

    TCSConfidential

    Page|8

    Declaration

    Ideclarethattothebestofmyknowledge,theanswerstothequestionsinthisformarecorrectandthatIamnotsuffering
    fromanydisease/illness,thepresenceofwhichIhavenotrevealed.Ifullyunderstandthatanymisrepresentationofthis
    declarationcouldleadtotheterminationofmyoffer/appointment.IhavenoobjectiontoTataConsultancyServicesPvt.Ltd.
    seekingfurtherinformationeitherdirectlyfrommeorfrommyConsultingdoctororotherappropriatedoctor.Incaseofany
    discrepancyarisingoutofmydeclaration,IwillbeundergoingthemedicalcheckupbytheCompanyssuggestedmedical
    clinic/doctorandtheirfindingswillbefullybindingonmeandanyactionthereontowardsmyemploymentwillbeaccepted
    byme.
    Signed:______________

    Date:(DD/MM/YY)___/___/___

    Section3TheCandidateneedstoensurethatalegallyqualifiedandregisteredmedicalpractitionerwithminimumqualification
    asM.B.B.S.completesthisform.Additionalsheetsmaybeattachedifmorespaceisrequired.
    Note:Thecandidateisresponsibleforanycostsassociatedwiththepreparationofthisreport.
    Section3:MedicalPractitionersdetails

    Fullname(aslistedonapplicablestateregistry)______________________________________________________
    RegistrationID:____________________________
    PostalAddress:_________________________________________________________________________________
    ContactNo:(Daytime)______________________

    Section4:GeneralExamination

    Bodywt:______kgs;

    Pulse:______/min;

    BP:___________mmHg;

    Height:______cms;

    Declaration

    _
    I,certifythatIhavecarefullyexaminedMr./Mrs./Ms./Miss/Dr________________________________son/daughterofMr.
    ___________________________________________________.
    _

    He/sheismedicallyfit/unfitforemploymentwithTCS.

    Remarks:________________________________________________________________________________________

    Signed&Sealed:______________

    Date:(DD/MM/YY)___/___/___

    TCSConfidential

    Page|9

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