CONCESSION CERTIFICATE

 

 

Paste Passport size photograph
duly signed and stamped by
the issuing Doctor.

Form for the purpose of grant of rail concession to Orthopaedically Handicapped /Paraplegic persons/patients to be used by the Government Doctor.

 

 

This is to certify that Km./Shri/Smt._________________________________whose particulars are furnished below, is a bonafide *Orthopaedically Handicapped / Paraplegic person / patient and CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORT.

 

 

 

 

 

 

Particulars of the Orthopaedically Handicapped / Paraplegic person / Patient:

 

 

(a)Address:__________________________________________________________________

 

 

(b) Father's Name:__________________________________________________________

 

 

(c) Age:__________________

(d) Sex   __________________

 

 

(e) Nature of Handicap : (to be written by Doctor
Whether the disability is Temporary or Permanent)        ___________________________________

 

 

(f) Causes of loss of functional capacity:           _________________________________________

 

 

(g) Signature or Thumb impression of Orthopaedically
 Handicapped / Paraplegic person / patient : (not
 necessary for those whose both hands are missing             ____________________________________
 or non functional

 

 

Place :_____________

_________________________________

 

 

Date :_____________

(Signature of Government Doctor)

 

 

___________________________

_______________________

 

 

Clear Seal of Government
Hospital / clinic

Seal Containing full name and
Regn. No. of the Doctor

 

 

*Strike out where not applicable

 

Note : 1) The Certificate should be issued only to those Orthopaedically Handicapped / Paraplegic persons / patients WHO CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORT. The photo must be signed and stamped in such a way that Doctor's signature and stamp appears partly on the photo and partly on the certificate.

 

 

 

 

 

 

 

2)In the case of temporary disability, the certificate will be valid for five years from the date of issue. In the case of permanent disability, the certificate will remain valid for 

(i) five years, in case of persons up to the age of 25 years,

(ii) ten years, in case of  Persons in the age group of  25 to 35 years and

(iii) in the case of persons above the age of  35 years, the certificate will remain valid for whole life of the concerned Person. 

After expiry of the period of validity  of the certificate, the person is required to obtain a fresh certificate. A Photostat copy of this 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.
 


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