Medical Certificates

FORM – 4

(See Rule-19)

Medical Certificate for Non-Gazetted Officer recommended leave or Extension of leave or commutation of leave.

Signature of Government Servant

………………………………   after   careful   personal   examination   of   the   case   hereby

certify that Shri / Smti / Kumari…………………………………………………………

whose signature  is given above  is suffering  from…………………………………….and I

consider  that  a  period  of  absence  from  duty  of  ………………………………………..

days   with   effect   from…………………………………is   absolutely   necessary   for   the

restoration of his / her health.

Date………………………..                                         Authorised Medical Attendant

FORM – 5

Medical Certificate of Fitness to Return to duty

Signature of Government Servant

I…………………………………………………..do hereby  certify that I have carefully

examined Sri / Smti / Kumari ………………………………………… whose signature is

given above and find that he/she recovered from his/her illness and is now fit to resume duties in Government Service. I also certify that before arriving at this decision, I have examined the original medical certificate and statement of the case (or certified copies thereof) on which leave was granted or extended and have taken into consideration in arriving at my decision.

Date……………………….                                                                       Authorised Medical Attendant.

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