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FORM – 5
FORM – 4
(See Rule-19)
Medical
Certificate for Non-Gazetted Officer
recommended
leave or Extension of leave or commutation of leave.
Signature of Government Servant
……………………………… after
careful personal examination of
the case hereby
certify that Shri / Smti / Kumari………………………………………………………………….
whose signature is given above is
suffering from………………………………………..and I
consider that a period of
absence from duty of ……………………………………………
days with effect
from…………………………………... is absolutely
necessary for the
restoration of his / her health.
Date………………………..
Authorised Medical Attendant
FORM – 5
Medical
Certificate of Fitness to Return to duty
Signature
of Government Servant
I……………………………………………………….....do
hereby certify that I have carefully
examined Sri / Smti / Kumari
……………………………………………... whose signature is
given above and find
that he/she recovered from his/her illness and is now fit to resume duties in
Government Service. I also certify that before arriving at this decision, I
have examined the original medical certificate and statement of the case (or
certified copies thereof) on which leave was granted or extended and have taken
into consideration in arriving at my decision
Date………………………. Authorised Medical Attendant
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