Appendix- 1/13
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Concession Certificate for the
purpose of Rail concession
to Blind Person
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CONCESSION CERTIFICATE
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Paste
passport
size
photograph
duly signed
and
stamped
by the
issuing
Doctor/Person
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Form for the purpose of grant of Rail concession to
completely Blind Persons to be used by Registered Medical
Practitioner/Government Doctor/Heads of the Institutions for the Blind
recognised by Ministry of Welfare/Govt. of India or Social welfare Dept. of
the concerned State government..
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This is
to certify that Kum/ Shri/ Smt
___________________________________ whose particulars are furnished below, is a COMPLETELY
BLIND PERSON
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Particulars of the
completely blind person:
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a) Address
:
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b) Father’s/Husband’s
Name :
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c) Age :
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d) Sex :
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e) Signature or Left Hand Thumb
Impression
of blind person
:
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______________________________
(Signature
of the Regd. Medical Practitioner or Govt. Doctor or Head of the Institution
for the Blind recognised by M/o Welfare, Govt. of India or Social welfare
dept. of the Concerned State Government)
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Place :
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Date :
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_____________________________
Clear seal of Government Hospital/ Clinic or Institution
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______________________________
Seal
containing full name and Regn. No
of
the certificate issuing Doctor.
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Note:
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1.
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This certificate should be issued only to COMPLETELY
BLIND PERSON. 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.
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The certificate is valid for five years from the date
of issue. After expiry ofThe period of validity of the certificate, the
person is required to obtain afresh certificate. A Photostat copy of this
certificate is accepted for thepurpose 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
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3.
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No alteration
in the form is permitted.
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