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Concession Certificate for
the purpose of Rail Concession to Cancer Patient
Appendix- 1/18
CONCESSION
CERTIFICATE
(Form for the purpose of grant
of Rail Concession to Cancer Patients to be used by the
Officer-incharge of theCancer Hospital Institute)
Station Master,
_______________________________
_______________________________
This is to certify that Kum/Shri/Smt
__________________________________________________ whose particulars are
furnished below, is a bonafide Cancer Patient required to travel from
_____________ _____________________________________ (Station) to
_________________________ (Station) * on discharge from/after
re-examination/periodical check up at
______________________________________ ____________________________________________
Cancer Hospital/Cancer Institute and is entitled to a single Journey ticket
on payment of 1/4 th
of the normal fare due/permission to travel accompanied by an attendant on
payment of 1/4 th
of normal fare for the escort in the class occupied.
Particulars of the Cancer Patient
Address:
a) Age:__________ b) Sex:___________
c) Personal Identification: (1)
_________________________________________________________
_____________________ __________________________________________________________
(2) __________________________________________________________
_______________________________________________________________________________
Signature or Left Hand Thumb: _____________________
Impression of the Patient.
_______________________________________________
(Officer- incharge of the Cancer Hospital/Institute)
Place :_______________________
Date :_______________________
_____________________________
Clear seal of Hospital/Institute.
* Strike out where not applicable. Indicate name of the hospital, etc.
Note:
1) The certificate is valid for three months from the date
of issue.
2) No alteration in the form is permitted unless attested by the Issuing
Officer.
3) Certificate should be issued to patients only for travelling from the
stations
serving his place of residence to the stations serving the
Hospital/Institute.
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