CONCESSION CERTIFICATE

Paste Passport size Photograph duly Signed and Stamped by the Form Issuing Doctor

Appendix-1/47
(See rule 101, Sl.No. 28) for the purpose of grant of rail concession to Totally Deaf & Dump persons (both afflictions together in the same persons) to be used by the Government Doctor.

This is to certify that Sri/Smt. Whose particular are furnished below, is a TOTALLY DEAF & DUMP PERSONS

Particular of the Totally Deaf & Dump persons: Address..................... ................................................................................................................................................ a) b) c) Fathers/Husbands Name. Age. d) sex..

Signature or left hand thumb impression of deaf & dumb person.

Place.. Date (Signature of the Govt. Doctor) . (Seal containing full name and Reg. no of the Doctor)

.. (Seal of Govt. hospital/clinic)

Note: (1) The certificate should be issued only to completely blind person. The photo must be signed and stamped by the certificate issuing Doctor/person in such a way that signature appears partly on the photo and partly on the certificate. (2) The certificate valid for five years from the date of issue. After expiry period of validity of the certificate the person is requested to obtain a fresh certificate. Photography of this certificate is accepted from the purpose of grant of concession. The original certificate will have to be produced for inspection at the time of purchase of concessional ticket and during the journey, if desired. (3) No alteration in the, form is permitted.