Registration No. …………………………………………………………. Dated: Seal. Note: Medical certificate granted by a qualified medical practitioner holding at least M.B.B.S. Degree and. |
This form must be filled out by a Physician / Physician's Assistant, licensed by the Colorado. Medical Board, or a Registered Nurse, licensed by the Colorado ... |
Medical Practitioner alongwith official seal. Date:Registration No. ……………………………………………………………………………. FITNESS CERTIFICATE. Signature of Applicant ... |
This is to certify that I have examined Mr./ Miss. He/ she is suffering / not suffering from following diseases. Asthma. Diabetes. Hypertension. |
He/She has no mental and physical disease and is fit. Signature of the Candidate. Place: Date: Signature of Medical Officer/Practitioner with legible seal. |
Based on the examination, I certify that she is in good physical and mental health, and is free from any physical disabilities which may interfere with her ... |
Marks of Identification. Signature of the Candidate. Place: Date: Name & signature of the Medical Officer with seal and registration number. * Strike whichever ... |
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