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Concession Certificate for the
purpose of Rail concession
to Kidney
Patient
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CONCESSION CERTIFICATE(for
Outward Journey)
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Form
for the purpose of issue of Rail concession to Kidney Patients
to be
used by Officer-In- Charge of the recognized Hospital
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This is
to certify that Kum/ Shri/ Smt
___________________________________ whose particulars are furnished below, is a bonafide Kidney Patient
and is required to travel alone or with escort
From ____________________________ (Station) to
_________________________ (Station) for *dialysis/kidney transplant Operation at ___________________________________
Hospital.
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Particulars of the Kidney 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 recognised Hospital)
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_____________________________ seal/Stamp of the recognized Hospital
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* delete the not applicable.
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Note:
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1.
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This certificate should be issued by Officer in-charge
of the recognised Hospital where the Kidney patient is being treated.
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2.
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The certificate is valid for three months from the
date of issue.
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3.
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No alteration in the form is permitted.
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4.
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Certificate should be issued to Kidney Patients only
for travel from the station serving his/her place of residence to the
station serving the hospital
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