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Appendix- 1/54
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Concession Certificate for the
purpose of Rail concession
to
Heart Patient
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CONCESSION CERTIFICATE
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Form
for the purpose of issue of Rail concession to Heart Patients
to be
used by Officer-In- Charge of Hospital
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This is
to certify that Kum/ Shri/ Smt
___________________________________ whose particulars are furnished below, is a bonafide Heart Patient
and is required to travel alone or with escort
From ____________________________ (Station) to
_________________________ (Station). The patient has secured admission for Heart Operation at
___________________________________ * Hospital.
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Particulars of the Heart Patient
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a) Address
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:
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b) Father’s/Husband’s
Name
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:
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c) Age
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:
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d) Sex
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:
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Place :
Date :
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Signature
:______________________________
(Officer-In-charge
of the Hospital)
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_____________________________ seal of Hospital
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* Indicate the name of the hospital.
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Note:
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1.
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The certificate is valid for three months from the
date of issue.
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2.
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No alteration in the form is permitted unless attested
by the issuing officer.
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3.
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Certificate should be issued to Heart Patients only
for travel from the station serving his place of residence to the station
serving the hospital
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