|
CONCESSION
CERTIFICATE |
|
|
|
|
Paste Passport size photograph |
Form for the purpose of grant of rail concession
to completely Blind persons to be used by a Regd. Medical
Practitioner/Government Doctor/Heads of the Institutions for the Blind
recognized by Ministry of Welfare/Govt. of India or Social Welfare
Deptt. of the concerned State Government |
|
|
|
This is to certify that Km./Shri/Smt.___________________________________________whose particulars are, furnished below, is a COMPLETELY BLIND PERSON. |
|
|
|
|
Particulars of the completely Blind person: |
|
|
|
|
(a) Address:___________________________________________________________________ |
|
|
|
|
(b) Father's /Husband's Name: ____________________________________________________ |
|
|
|
|
(c) Age:______________________ |
(d) Sex _______________________________ |
|
|
|
|
||
|
|
||
|
(e) Signature or left hand Thumb |
|
|
|
|
Place :_____________ |
________________________________________ |
|
|
|
Date :_____________ |
(Signature of Regd. Medical Practitioner/Government Doctor/Heads of the Institutions for the Blind recognized by Ministry of Welfare/Govt. of India or Social Welfare Deptt. of the concerned State Government). |
|
|
|
___________________________ |
_______________________ |
|
|
|
Clear Seal of Government |
Seal Containing full name and Regn. No.of the certificate issuing Doctor/person |
|
|
|
Note : 1). The Certificate should be issued only to those COMPLETELY BLIND PERSONS. The photo must be signed and stamped by the certificate issuing Doctor/person in such a way that the signature and stamp appears partly on the photo and partly on the certificate. |
|
|
|
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
2). The certificate is valid for five years from the date of issue. After expiry of the period of validity of the certificate, the person is required to obtain a fresh certificate. A Photostat copy of the certificate is accepted for 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 demanded. |
|
|
|
|
|
|
||
|
|||
|
3). No alteration
in the form is permitted. |
|
|
|
|
|
|
||