CERTIFICATE OF MEDICAL FITNESS

Signature of Applicant: .....................................

I, Dr. ......................................................... do hereby
certify that I have carefully examined Mr./
Mrs. .................................................... hose signature is
given above, is fit both physically and mentally for duties in
!overnment / "rivate or any other organi#ation. I also certify
that before arriving at this decision, I have carefully examined
her previous medical treatment status.

M$DI%A& '((I%$)
&ocation:
Date: