TRM 2
(Note A to Item XI of Annexure I to Chapter 8)
Form of certificate to be issued by a medical practitioner
nominated by Indian mission etc. abroad
MEDICAL CERTIFICATE
I hereby certify that I have recently personally examined____________________________________________
                                                                                           (Name - Block Letters)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
                                                                (address)
and he/she is suffering from____________________________________________________________________
_____________________________________________________________________________________________
                                                                (ailment).
I recommend that he/she undergoes immediate medical treatment for which he/she will be required to stay for about_______________days in_________________________________________________________
                                                                (Name of the country)
The cost of the medical treatment will be approximately ___________________________________
Place:.................. Date:................... | _________________________________ (Signature of Medical practitioner) |
|
Name_________________________________
Designation____________________________
Registration No.________________________
Address_______________________________
_____________________________________
_____________________________________