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    Form 1-A (See Rules 5 (1), (3), 7,10 (A), 14 (D), and 18 (D) ) : Certificate of Medical Fitness

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    tilak
    1. The document is a medical certificate for a driving license applicant named Girdhar Gopal Joshi. 2. The certificate details the applicant's physical examination, including vision, hearing, defects, and medical fitness to drive. 3. The examining medical officer certified that the applicant was medically fit to hold a driving license based on the examination.

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    Form 1-A (See Rules 5 (1), (3), 7,10 (A), 14 (D), and 18 (D) ) : Certificate of Medical Fitness

    Uploaded by

    tilak
    114 views1 page
    1. The document is a medical certificate for a driving license applicant named Girdhar Gopal Joshi. 2. The certificate details the applicant's physical examination, including vision, hearing, defects, and medical fitness to drive. 3. The examining medical officer certified that the applicant was medically fit to hold a driving license based on the examination.

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    form 1 a

    Original Title

    FORM 1 A

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    1. The document is a medical certificate for a driving license applicant named Girdhar Gopal Joshi. 2. The certificate details the applicant's physical examination, including vision, hearing, defects, and medical fitness to drive. 3. The examining medical officer certified that the applicant was medically fit to hold a driving license based on the examination.

    Copyright:

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

    Form 1-A (See Rules 5 (1), (3), 7,10 (A), 14 (D), and 18 (D) ) : Certificate of Medical Fitness

    Uploaded by

    tilak
    1. The document is a medical certificate for a driving license applicant named Girdhar Gopal Joshi. 2. The certificate details the applicant's physical examination, including vision, hearing, defects, and medical fitness to drive. 3. The examining medical officer certified that the applicant was medically fit to hold a driving license based on the examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    FORM 1-A

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


    Appl No:1019303622 Dt:09-03-2022
    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 : GIRDHAR GOPAL JOSHI

    2. Identification marks : 1.................................

    3. 2.................................
    (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
    which would prevent his hearing the ordinary sound signals ?

    (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 O+
    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: GIRDHAR GOPAL JOSHI
    (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 : 28-10-2016 ( GIRDHAR GOPAL JOSHI )

    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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