Pension Rule No.59: Form Of Medical Certificate

59. Form Of Medical Certificate:-

The medical certificate shall be in the following form:

Certified that I/We have carefully examined AB son of CD ——————— a in the ——————— his age is by his own statement, is ——————— years, and by appearance about ——————— years.

I/We consider ——————— AB to be completely and permanently incapacitated for further service of any kind (or in the department to which he belongs) in consequence of – ——————– (here state disease or cause). His incapacity does not appear to me/us to have been caused by irregular or intemperate habits.

Note:- If the incapacity is the result of irregular or intemperate habits, the following will be substituted for the last sentence: –

In my/our opinion his incapacity is directly has been due to accelerated or aggravated by irregular intemperate habits.

(If the incapacity does not appear to be complete and permanent, the certificate should be modified accordingly and the following addition should be made): –

I am/We are of the opinion that ——————— AB is fit for further service of a less laborious character than that which he has been doing (or may, after resting for —————–months be fit for further service of a less laborious character than that which he has been doing).