RAILWAY CONCESSION CERTIFICATE FOR ORTHOPAEDICALLYHANDICAPPED PARAPLEGIC PERSONS / PATIENTS(C.C. RES. 5830 and 5834 (B) C.S.No.47. dt.

28-5-1998Page 217,APPENDI X 1/36, Substitute the follows)RAILWAY CONCESSION CERTIFICATEAPPENDIX - 1/36(Rul e 101, Serial No. 25)Form for the purpose of Grant of Railway Concession Certifi cate theOrthopaedically Handicapped / Paraplegic Persons / Patients to beIssued by the Govt. DoctorThis is to certify that Kumari / Sri / Smt.Whose particulars are furnished below is a Bonafied Orthopaedically Handicapped/ParaplegicPerson/P atient andCANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORTPARTICULARS OF THE OR THOPAEDICALLY HANDICAPPED / PARAPLEGIC PERSON / PATIENTa)Addressb)Father s / Husband amec)Age ______________(d) Sexe) Nature of Handicapped(To be written:by Doctor w hether the disability isTemporary or Permanent)f) Causes of Loss in functional c apacity :g) Signature of Thumb impression oforthopaedically handicapped / parapl egic person / patient(Not necessaryfor those whose both hands are missingor not functional.Place :Signature of the Government DoctorDate :Seal containing full N ame & Regd.No.of the Doctor.Clear Seal ofGovt. Hospital / Clinic*Strike out wher e not applicable.Note :1. This certificate should be only to the Orthopaedically Handicapped / Paraplegic Person / Patient who can travel withoutthe assistance of an escort. The Photo must be signed and stamped in such a way that Doctor s Signa ture and stampappearly partly on the Photo and partly on the Certificate.2. In t he case of temporary disability,the certificate will be valid for 5 years from t he date of issue in the case of permanentdisability, the certificate will remain valid for (1)five Years in case of persons upto the age of 25 years. (2) 10 yea rs in caseof persons in the age of 26 to 35 years (3)In case of person the age a bove 35 years the certificate will remain valid forwhole life of the concerned p erson. After expiry of the period of validity of the certificate person is requi red to obtain a freshcertificate. A photostat copy of this certificate is accept ed for the purpose of grant of concession. The original certificate willhave to be produced for inspection at the time of purchase of concessional ticket and du ring the journey, if demand.3. No alteration in the from is permitted. (Inforce From 1-1-1999)FROM ____________________________ TO ________________________________ Ticket No.Signa ture of the Passenger Signature of the issuing Persons.Paste photoSignatureof th e Govtdoctor with seal of 1

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