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Form 42 Medical Certificate

The document is a certificate of health form used to certify that an applicant seeking admission to a training institution in Kerala State does not have any physical deformities, blindness, deafness, speech defects, or diseases that would prevent them from performing the duties of a teacher. The form requires the certifying doctor to note any exceptions, the applicant's age, and personal marks of identification.

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Pm Dhanesh
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7K views1 page

Form 42 Medical Certificate

The document is a certificate of health form used to certify that an applicant seeking admission to a training institution in Kerala State does not have any physical deformities, blindness, deafness, speech defects, or diseases that would prevent them from performing the duties of a teacher. The form requires the certifying doctor to note any exceptions, the applicant's age, and personal marks of identification.

Uploaded by

Pm Dhanesh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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419

FORM 42
(See Rule XXV-18(2)(b))
CERTIFICATE OF HEALTH
I do hereby certify that I examined (full name) …………………….. an
applicant seeking admission to training institution in the Kerala State and cannot
discover that he/she has any physical deformity, blindness of one or both eyes 'or
deafness or stammering or stuttering or other defect of speech. I further certify that I
cannot discover that he/she has any disease, constitutional affection or bodily
infirmity except …………………………………… I do not consider this would affect
his/her performing efficiently the duties of a teacher, and taking active part in
physical or other manual activities.
His/her age is years, according to his/her own statement and by appearance
………………………… year. I certify that he/she has marks of small-
pox/vaccination.

Personal marks of identification.


1.
2.
3.
Signature

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