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Pre Employment Medical Fitness Certificate PRE – EMPLOYMENT

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									                           PRE – EMPLOYMENT MEDICAL EXAMINATION

Please carry with you the completed medical fitness certificate from a registered medical official/
practitioner along with the reports (X-ray, Blood, Urine etc) at the time of joining. You may complete the
medical examination in Hyderabad or the city where you are currently residing as per the list of network
hospitals mentioned in Connexion- our virtual tool for the completion of your on boarding process. We
would reimburse the expenses incurred on actuals subject to a maximum amount of Rs 1200/- only (Rupees
One Thousand Two Hundred only) for which you have to submit bills from the place where you have done
the medical examination.

Name                        :          _________________
Age                         :          __________ years              Sex        :   Male   Female
S.No                                                    Investigation
        Cardio    Vascular
  1
        System (ECG)

        Complete    Blood
  2
        Count & ESR

        Abdominal
  3
        Investigation (USG)

  4     Urine


  5     X-Ray Chest

        Vision                    L:                                       R:
  6
        Color Vision
                                                        Examination

  1     BP/Pulse


  2     Respiratory System

Any other observation by the Medical Examiner:

______________________________________________________________________________________

                                   MEDICAL FITNESS CERTIFICATE

After examining Mr. /Ms. ________________________ I hereby certify that he/she is FIT / UNFIT for
employment.

Date     :         ____________________                                                              Paste the
                                                                                                    candidates
Signature of the Medical Official: _____________________________                                    photograph

Name of the Medical Official:          _____________________________

(Please affix a seal/stamp of the medical official / practitioner)


Please disclose history of any significant illness or treatment you have gone through in the last 3 years.
(To be filled by employee)
 ………………………………………………………………………………………………………………..

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