Mentally Retarded Person Concession Certificate

CONCESSION CERTIFICATE
Appendix No. 1/48
Paste passport size photograph Duly signed and stamped By the issuing doctor
Form for the purpose of grant of rail concession to mentally retarded person issued by the Government Doctor

This is to certify that km./Shri/Smt______________________________________ whose particulars are furnished below, is a bonafide Mentally retarded person and CANNOT TRAVEL WITHOUT AN ESCORT.
Particulars of the mentally retarded person:
(a) Address_________________________________________________________
(b)Father’s/Husband’s Name___________________________________________
(c)Age__________________________________ (d) Sex____________________
(e) Signature or thumb impression of Mentally Retarded
person _____________________________________________
_________________________________
(Signature of the Government Doctor)
Place:_________________________
Date:__________________________
……………………………………………………..
Clear seal of government Seal Containing full name
Hospital/Clinic and regn.no of the doctor
Note: (1) The Certificate should be issued only to the Retarded persons WHO CANNOT TRAVEL WITHOUT 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)The certificate is valid for 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 of the form is permitted.