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CERTIFICATE OF MEDICAL FITNESS - DOC by keithmurray

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									                                  CERTIFICATE OF MEDICAL FITNESS
                                           ( Only applicable for Hotel Management Candidate)
                                          (To be filled in by a Registered Medical Practitioner)


NAME:_____________________________________________________________________________

ADDRESS:_________________________________________________________________________

CITY/STATE:_______________________________________________________________________

                    ________________________________________________________________

                     Has the applicant suffered from Appendicitis /Trachoma/Tuberculosis/Epilepsy/ Venereal Diseases?
----------------------------------------------------------------------------------------------------------------------------- ------------------------

-----------------------------------------------------------------------------------------------------------------------------------------------------


Allergic to any Medicine/Product------------------------------------------------------------------------------------

Undergone any major operation--------------------------------------------------------------------------------------

Blood Group---------------------------------------------RH Factor---------------------------------------------------

Identification Mark:----------------------------------------------------------------------------------------------------


I Dr. _______________________________________Regd.No._______________certify that the above
candidate is not suffering from any of the diseases mentioned below, nor from any other disease, which
may be contagious, infectious or harmful to others. He/She is in good mental and physical health and is
free from any physical defects, which may interfere with his/her studies including the active outdoor
duties required of a professional.



DATE:                                                                                 PLACE:



_____________________________________
Signature of Medical Practitioner(With Stamp)

                                                                                                                    APPLICANT
                                                                                                                   PHOTOGRAPH




Note: The Medical Officer will put his signature over the photograph affixed in such a manner
that part of his/her signature is upon the photograph and part on the certificate.

								
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