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CONCESSION
CERTIFICATE |
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Paste Passport size photograph |
Form for the purpose of grant of rail concession to Mentally Retarded persons to be used by the Government Doctor. |
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This is to certify that Km./Shri/Smt. ________________________________________________whose particulars are furnished below, is a bonafide Mentally Retarted person and CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORT. |
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Particulars of the Mentally Retarted person : |
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(a) Address:_______________________________________________________________________ |
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(b) Father's /Husband's Name: _________________________________________________________ |
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(c) Age:______________________ |
(d) Sex _______________________________ |
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| (e) Signature or Thumb impression of Mentally Retarded Person :____________________________ | |||
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Place :_____________ |
_________________________________ |
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Date :_____________ |
(Signature of Government Doctor) |
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___________________________ |
_________________________________________ |
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Clear Seal of Government |
Seal Containing full name and Regn. No. of the Doctor |
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| Note : 1) The Certificate should be issued only to those Mentally Retarted 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. | |||
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| (2) The Certificate is Valid for a period of 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 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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