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    Transport Department. Govt of NCT of Delhi: Form 1-A (See Rules 5 (1), (3), 7,10 (A), 14 (D), and 18 (D) )

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    Rahul
    1. This is a medical certificate for a driver's license applicant named Mona Sharma. 2. The examining doctor found that Mona Sharma has 20/20 vision with corrective lenses, can distinguish license plates from 25 meters away, does not suffer from deafness or night blindness, and has no physical defects that would interfere with driving duties. 3. The doctor certified Mona Sharma as medically fit to hold a driving license.

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    Transport Department. Govt of NCT of Delhi: Form 1-A (See Rules 5 (1), (3), 7,10 (A), 14 (D), and 18 (D) )

    Uploaded by

    Rahul
    57 views1 page
    1. This is a medical certificate for a driver's license applicant named Mona Sharma. 2. The examining doctor found that Mona Sharma has 20/20 vision with corrective lenses, can distinguish license plates from 25 meters away, does not suffer from deafness or night blindness, and has no physical defects that would interfere with driving duties. 3. The doctor certified Mona Sharma as medically fit to hold a driving license.

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    1. This is a medical certificate for a driver's license applicant named Mona Sharma. 2. The examining doctor found that Mona Sharma has 20/20 vision with corrective lenses, can distinguish license plates from 25 meters away, does not suffer from deafness or night blindness, and has no physical defects that would interfere with driving duties. 3. The doctor certified Mona Sharma as medically fit to hold a driving license.

    Copyright:

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

    Transport Department. Govt of NCT of Delhi: Form 1-A (See Rules 5 (1), (3), 7,10 (A), 14 (D), and 18 (D) )

    Uploaded by

    Rahul
    1. This is a medical certificate for a driver's license applicant named Mona Sharma. 2. The examining doctor found that Mona Sharma has 20/20 vision with corrective lenses, can distinguish license plates from 25 meters away, does not suffer from deafness or night blindness, and has no physical defects that would interfere with driving duties. 3. The doctor certified Mona Sharma as medically fit to hold a driving license.

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    © All Rights Reserved
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    FORM 1-A

    [See rules 5(1),(3),7,10(a),14(d), and 18(d)]


    Appl No:1519543922 Dt:13-04-2022
    MEDICAL CERTIFICATE
    [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 : MONA SHARMA

    2. Identification marks : 1.NA


    2.NA
    3.
    (a) Does the applicant, to the best of your judgment, suffer from any defect
    of vision? If so, has it been corrected by suitable spectacles ? Yes/No

    (b) 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 ?

    (c) In your opinion, does the applicant suffer from a degree of deafness Yes/No
    TRANSPORT DEPARTMENT.
    which would prevent his hearing the ordinary sound signals ? GOVT OF NCT
    OF DELHI
    (d) In your opinion, does the applicant suffer from night blindness ? Yes/No

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

    (f) Optional
    (a) Blood group of the applicant (if the applicant so desires that the Unknown
    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) that I have personally examined the applicant Shri/Smt/Kum: MONA SHARMA
    (ii) that while examining the applicant I have directed special attention to her/his distant vision;
    (iii) while examining the applicant, I have directed special attention to his/her hearing ability, the conditon of the arms,
    legs, hands and joints of both extremities of the applicant;
    (iv) 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 dangerour or hazardous nature to
    human life); and
    (v) Applicant's colour vision has been tested using standard ishihara chart and the applicant has not been found
    suffering from severe or total colour blindness.
    And, therefore, I certify that, to the best of my judgment, he is medically fit/not fit to hold a driving licence.
    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

    Date : 13-04-2022 ( MONA SHARMA )

    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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