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    Form 1-A: Certificate of Medical Fitness

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    kavitha chinnadurai
    1. This is a medical certificate for a driving license applicant named Kavitha C. 2. The doctor conducted various medical tests to check vision, color blindness, hearing, physical defects, and reaction time. 3. The doctor certified that Kavitha C is medically fit to hold a driving license based on the examination. No medical reasons were found to declare the applicant unfit.

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    Form 1-A: Certificate of Medical Fitness

    Uploaded by

    kavitha chinnadurai
    343 views1 page
    1. This is a medical certificate for a driving license applicant named Kavitha C. 2. The doctor conducted various medical tests to check vision, color blindness, hearing, physical defects, and reaction time. 3. The doctor certified that Kavitha C is medically fit to hold a driving license based on the examination. No medical reasons were found to declare the applicant unfit.

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    1. This is a medical certificate for a driving license applicant named Kavitha C. 2. The doctor conducted various medical tests to check vision, color blindness, hearing, physical defects, and reaction time. 3. The doctor certified that Kavitha C is medically fit to hold a driving license based on the examination. No medical reasons were found to declare the applicant unfit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    343 views1 page

    Form 1-A: Certificate of Medical Fitness

    Uploaded by

    kavitha chinnadurai
    1. This is a medical certificate for a driving license applicant named Kavitha C. 2. The doctor conducted various medical tests to check vision, color blindness, hearing, physical defects, and reaction time. 3. The doctor certified that Kavitha C is medically fit to hold a driving license based on the examination. No medical reasons were found to declare the applicant unfit.

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    © All Rights Reserved
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    FORM 1-A Appl No:2487252820 Dt:11-09-2020

    MEDICAL CERTIFICATE
    [See rules 5(1),(3),7,10(a),14(d), and 18(d)]
    [To be filled in by a registered medical practitioner appointed for the purpose by the State Government or person
    authorised in this behalf by the State Government referred to under sub section (3) of section 8]

    1.Name of the applicant : KAVITHA C

    2. Identification marks : 1.A BLACK MOLE ON NOSE


    2.A SCAR LEFT KNEE
    (a) Does the applicant, to the best of your judgment, suffer from any defect Yes / No
    of vision? If so, has it been corrected by suitable spectacles ?

    (b) Can the applicant, to the best of your judgment, readily distinguish the Yes / No
    pigmentary colours, red and green ?

    (c) In your opinion, is he able to distinguish with his eye sight at a distance of 25
    Yes / No
    metres in good day light a motor car number plate ?

    (d) In your opinion, does the applicant suffer from a degree of deafness Yes / No
    which would prevent his hearing the ordinary sound signals ?

    (e) In your opinion, does the applicant suffer from night blindness ? Yes / No

    (f) Has the applicant any defect or deformity or loss of member which would
    interfere with the efficient performance of his duties as a driver? If so, give Yes / No
    your reasons in details.

    (g) Optional
    (a) Blood group of the applicant (if the applicant so desires that the ..........................
    information may be noted in his driving licence).

    (b) RH factor of the applicant (if the applicant so desires that the ..........................
    information may be noted in his driving licence).
    Declaration made by the applicant in Form 1 as to his physical fitness is attached
    Certificate of Medical Fitness
    I certify that I have personally examined the applicant Shri/Smt/Kum: KAVITHA C
    I also certify that I have personally examined the applicant I have directed special attention to her/his distant vision,
    hearing ability, the condition of the arms, legs, hands and joints of both extremities of the applicant; and I have
    personally examined the applicant for reaction time, side vision and glare recovery (applicable in case of persons
    applying for a licence to drive goods carriage carrying goods of dangerous or hazardous to human life) And, therefore,I
    certify that, to best of the my judgment he is medically fit/no fit to hold a driving license.
    The applicant is not medically fit to hold a licence for the following reasons : -

    Signature :
    1. Name and designation of the of Medical Officer / Practitioner

    (Seal)
    2. Registration Number of Medical Officer

    Signature or thumb impression of the candidate

    ( KAVITHA C )
    Date :
    Note : -1. The medical Officer shall affix his signature over the photograph affixed in such a manner that part
    of his signature is upon the photograph and part on the certificate.
    2. Dumb persons without deafness may be granted a valid certificate of driving licence for
    non-transport vehicle. __________

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