Appendix- 1/47
Concession Certificate for the purpose of Rail concession to Deaf & Dumb Person
CONCESSION CERTIFICATE
Paste passport size photograph duly signed and stamped by the issuing Doctor/Person		Form for the purpose of grant of Rail concession to Totally Deaf & Dumb Persons(Both afflictions together in the same person) to be used by the Government Doctor.
This is to certify that Kum/ Shri/ Smt ___________________________________ whose particulars are furnished below, is a TOTALLY DEAF & DUMB PERSON
Particulars of the totally deaf & dumb person:
a) Address :
b) Father’s/Husband’s Name :
c) Age :
d) Sex :
e) Signature or Left Hand Thumb Impression of deaf & dumb person :
			______________________________ (Signature of the Govt. Doctor)
Place :
Date :
_____________________________ Clear seal of Government Hospital/ Clinic or Institution			______________________________ Seal containing full name Regn. No of the Doctor
Note:
1.	This certificate should be issued only to TOTALLY DEAF & DUMB PERSONS (BOTH AFFLICTIONS TOGETHER IN THE SAME 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.
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 in the form is permitted.