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    PWD Certificate Format

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    Sourav Panda
    This document provides the format for a Physically Challenged/Persons with Disabilities certificate issued by a medical board. The format includes fields for the candidate's photograph, personal details, disability details including type and percentage, recommendations for reassessment, and signatures of three doctors on the medical board including their specializations. Guidelines note that the certificate must be issued by a medical board of at least three doctors constituted under the Persons with Disabilities Act, and that a minimum of 40% disability is required to be considered under the physically challenged category.

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    PWD Certificate Format

    Uploaded by

    Sourav Panda
    5K views1 page
    This document provides the format for a Physically Challenged/Persons with Disabilities certificate issued by a medical board. The format includes fields for the candidate's photograph, personal details, disability details including type and percentage, recommendations for reassessment, and signatures of three doctors on the medical board including their specializations. Guidelines note that the certificate must be issued by a medical board of at least three doctors constituted under the Persons with Disabilities Act, and that a minimum of 40% disability is required to be considered under the physically challenged category.

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    The format for PWD

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    This document provides the format for a Physically Challenged/Persons with Disabilities certificate issued by a medical board. The format includes fields for the candidate's photograph, personal details, disability details including type and percentage, recommendations for reassessment, and signatures of three doctors on the medical board including their specializations. Guidelines note that the certificate must be issued by a medical board of at least three doctors constituted under the Persons with Disabilities Act, and that a minimum of 40% disability is required to be considered under the physically challenged category.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    5K views1 page

    PWD Certificate Format

    Uploaded by

    Sourav Panda
    This document provides the format for a Physically Challenged/Persons with Disabilities certificate issued by a medical board. The format includes fields for the candidate's photograph, personal details, disability details including type and percentage, recommendations for reassessment, and signatures of three doctors on the medical board including their specializations. Guidelines note that the certificate must be issued by a medical board of at least three doctors constituted under the Persons with Disabilities Act, and that a minimum of 40% disability is required to be considered under the physically challenged category.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    PwD Certificate Format

    PwD Certificate Format

    Format for Physically Challenged (PH)/Persons with Disabilities (PwD) Certificate


    (To be obtained by the candidate)
    (To be filled by Medical Board notified under PwD Act)
    Affix he re rece nt
    Photog raph showing
    the disability duly
    Certificate No:
    attested by Medical
    Date: Superinte ndent
    /CMO/Head of
    Hospital (with seal)

    This is to certify that Mr./Ms______________________________________________________________ son / daughter of


    Mr./Mrs._____________________________________________________ Age ______________male/female, Registration
    No._____________________________is a case of ______________________________. He/She is physically disabled/visual
    disabled/speech and hearing disabled/having mental retardation/leprosy cured and has ______ %(______________________per
    cent) permanent (physical impairment/visual impairment/speech and hearing impairment etc.) in relation to his/her
    __________________________________________.

    Note:
    This condition is progressive/not progressive/likely to improve/not likely to improve*.

    1. Re-assessment is not recommended/ is recommended after a period of___________ months /years*.


    (*Strike out whichever is not applicable)

    Signature of Dr. Signature of Dr. Signature of Dr.


    Name of Dr. Name of Dr. Name of Dr.
    Specialization Specialization Specialization

    Seal with Degree Seal with Degree Se al with Degre e


    (Member, Medical Board) (Member, Medical Board) (Member, Medical Board)

    Signature/Thumb impression of Patient


    Countersigned by the
    Medical Superintendent/CMO/Head of Hospital (with seal)

    Information/Guidelines:

    1) Disability c ertific ate shall be issued by Medic al Board of at leas t three doc tors duly constituted by the S tate or Central
    government under P WD Ac t.(One of the members of the Board s hould be the spec ialist in the partic ular field for assessing
    Locomotor, Visual dis ability ,Hearing and S peec h dis ability ,Mental disorder and Leprosy c ured)
    2) For c andidature under physic ally c hallenged c ategory, c andidates only with a minimum of 40% dis ability is require d.
    3) The Medic al Board at Reporting Center of CCM T will assess the Physic ally Challenged (PH) c ertific ate. In c ase there is serious
    doubt about perc entage of disability/ genuineness of the c ertific ate, the c andidate will be referred for reassessment to the
    Medic al Board duly c onstituted by the S tate or Central Government under PWD Ac t.

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