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Medical Certificate

1. The document is a medical certificate for a driving license application submitted by Neeru Bhatia. 2. The examining doctor found Neeru to have 20/20 vision with corrective lenses, able to read license plates from 25 meters, no hearing or visual impairments, full mobility of limbs, and no medical reasons why she could not drive safely. 3. The doctor certified that Neeru is medically fit to hold a driving license.

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Himanshu
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441 views1 page

Medical Certificate

1. The document is a medical certificate for a driving license application submitted by Neeru Bhatia. 2. The examining doctor found Neeru to have 20/20 vision with corrective lenses, able to read license plates from 25 meters, no hearing or visual impairments, full mobility of limbs, and no medical reasons why she could not drive safely. 3. The doctor certified that Neeru is medically fit to hold a driving license.

Uploaded by

Himanshu
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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FORM 1-A

See rules 5(1).(3),7,10(a), 14(d), and 18(d)] Application Date:


MEDICAL CERTIFICATE
(To be filled in by a registered medical Practitioner appointed for th9
authorised in this behalf by the State purpose by the State Government or
peio
1.Name of the applicant
Govetnent relerred
NEERU BHATIA
to under sub section
(3) of section 8|
1A-SonWife/Daughter of MR MUKESH KUMAR
BHATIA
1B-Permanent address B6/7, SAINIK NAGAR NEAR TAM
NAWADA METRO STATION, OTTA
NAGAR.WEST DELHI, 110059
1C-Date of birth 05-01-1972
2. Identification marks
*** ************

3.
(a) Does the applicant, to the best of your judgment,
süffer trom any defect
of vision? If so, has it been corected by suitable Yes/No
spectacles?
(b) In your opinion, is he able to distinguish with his eye sight ata distance
Yes/No
of 25 meters in good day light a motor car number plate ?
(c) In your opinion, does the applicant suffer from a degree of deafness
which would prevent his hearing the ordinary soundsignals? Yes/No
(d) In your opinion, does the applicant suffer from night blindness ?
Yes/No
(e) Has the applicant any defect or deformity or loss of member which would
interfere with the efficient performance of his duties as a driver? If so, give Yes/No
your reasons in details.
(f) Optional
(a) Blood group of the applicant (if the applicant so desires that the B+
information may be noted in his driving licence).

(b) RH factor of the applicant (if the applicant so desires that the ***********

information may be noted in his driving licence).


Declaration made by the applicant in Form 1 as to his physical fitness is attached

Certificate of Medical Fitness


Icertifythat:
) that I have personally examined the applicant Shri/Smt/Kum: NEERU BHATIA
attention to her/his distant vision;
(i) that while examining the applicant I have directed special
attention to his/her hearing ablity, the conditon of the arms,
(ii) while examining the applicant, I have directed special
legs, hands and joints of both extremities of the applicant
side vision and glare recovery, (applicable in case of
iv) I have personally examined the applicant for reaction time, to
persons for a licence to
applying drive goods carriage carrying goods of dangerour or hazardous nature
human life); and
the applicant has not been found
(v) Applicant's colour vision has been tested using standard ishihara chart and
colour blindness".
suffering from severe or total
he is medically Fitoibida ddving licence.
And, therefore, certity that, to the best of my judgment,
I
The applicant is FitvUMAhold a licence for the following reasonsS:
Signature : 2
1. Name and designation of the of Medlcal Officef / Practitioner
6 4M
, e

(Seal)
2. Registration Number of Medical Officer:

Signature or thumb impression of the candidate


Date
(NEERUBHATIA)
Note:-1. The medical Officer shall affix his signature over the photograph affixed in such a manner that part
of his signature is upon the photograph and part on the certificate.
2. Dumb persons without deafness may be granted a valid certificate of driving licence for
non-transport vehicle.

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