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Form M.C.C.: Form of Medical Certificate For A Conductor | PDF | Law
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Form M.C.C.: Form of Medical Certificate For A Conductor

The form collects information such as the name, age, and identifying marks of the person examined. It asks the medical practitioner to certify whether the person is physically and mentally fit to be a conductor, and if they show any signs of addiction. The practitioner must also confirm that the attached photograph is a true likeness of the person described on the form.

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10K views1 page

Form M.C.C.: Form of Medical Certificate For A Conductor

The form collects information such as the name, age, and identifying marks of the person examined. It asks the medical practitioner to certify whether the person is physically and mentally fit to be a conductor, and if they show any signs of addiction. The practitioner must also confirm that the attached photograph is a true likeness of the person described on the form.

Uploaded by

kumar
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 M.C.C.

(See Rule 52)

Form of Medical Certificate For A Conductor


(To be filled in by a Registered Medical Practitioner)

1. Name of person examined :....................................................................................

2. Father’s name :....................................................................................

3. Apparent age :....................................................................................

4. Is the person examined to the best of your


judgement fit physically and mentally to the
duties of a conductor of a stage carriage :...................................................................................

5. Does he show any evidence of being addicted


to the excessive use of alcohol or drugs. :...................................................................................

6. Marks of Identification :...................................................................................

I Certify that the person examined has affixed his signature in my presence and that to the best of my
knowledge and belief the above statements are true and that the attached photograph is a reasonable
correct likeness of the person described.

................................................
Signature of person examined

Name :......................................................................

Space for Photograph Signature :......................................................................

Designation :......................................................................

Register No :......................................................................

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