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    Medical Certificate PDF

    Uploaded by

    Kawsher Raquib

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd

    Medical Certificate PDF

    Uploaded by

    Kawsher Raquib
    7K views1 page

    Original Title

    Medical Certificate pdf

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    Copyright:

    © All Rights Reserved
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    7K views1 page

    Medical Certificate PDF

    Uploaded by

    Kawsher Raquib

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Download as pdf
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    pes tya- instruc NrigssD Medical Certificate Form for BRTA Di 2,Ta be filled up by practitioner 1 \-2828 ILTANA Ottcer ‘Te Se Perle WO) ‘Applicant Details capo. 1. wmatis the applicant's apparent age? ele] 2.1 there any defect of vision? ves [¥] No 5.70, has it been corrected by sutable spectacles? [ves [] vo 4. Gan the eppzanis realy cistingush he pigmentary colors ed and green? [ives [] vo 5. Does the applicant sufor rom night blindness? [ves [7] No «6. Does the applicant sulfer from a degree of deafness which wound prevent his hearing the ordinary sound signals? ve [v7] No 7. Has the applicant any deformity or loss of members wich woul interfere wth sa eet verformone of his dutes 28a dhver? Lives [v] No 4. Dove he show any evidence of being adsictd othe excessive use ofalahol or dugs? [ves [7] No «,ishe your option, general ft 2s regard (a) Bolly heath, and () eyesight? [Jves [] vo 40. Matks of Kentiction HEROS EORHONHE OwwoOeoooooo | cenity that to the best of my knowledge and belief the applicant S. M, RAQUIB UDDIN KAWSHER is the person herein above described and that the atlached photograph is a reasonably correct likeness. 41. Medical Practitioner's Name RIVA eS OAeS 12, Medical Practitioner's Designation, i CHF OMe MeAEOEE 44, Medical Practitioner's Signature: Nos canaggp gute on nang ea. eS agen PAGE

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