INVESTMENTS LIMITED

CONFIDENTIAL

MEDICAL CERTIFICATE FOR BCM (GROUP) EMPLOYEES

I hereby certify that on 20 I medically examined

Mr./Mrs./Miss .

1. He/She does/not suffer from morbid condition on the eyes or lids which be subject to the risk of
aggravation or recurrence.

2. Ears 8. Urinary System

3. Circulatory System Urine Examination…………………..

a. Heart………………………………… a. Specific Gravity………………............

b. Pulse Rate…………………………… b. Albumen………………………………
c. Blood Pressure………………………. c. Sugar………………………………….
d. ECG…………………………………. d. Deposit…………………………………

4. Respiratory System 9. Biochemical Profile

a. Lungs…………………………………. a. Cholesterol…………………….
b. X-ray…………………………………. b. HDL……………………………
c. Triglycerides…………………..
5. Alimentary System d. FBS…………………………....
a. Liver………………………………….. e. Urea……………………………
b. Spleen………………………………… f. Creatinine………………………
c. Hernia………………………………… g. Uric Acid & CT……………….

6. Nervous System 10. Hemoglobin Profile

a. Pupillary Reflexes…………………….. HB………………………………...
b. Knee Jerk……………………………… ESR……………………………….
c. Parter Jerks……………………………. Sickling Test……………………...

7. Blood Cholinesterase Level……………… 11. HIV……………………………….

12. Hepatitis…………………………..

13. Tuberculosis………………………

14. Any physical Disability (Specify): ……………………………………………………………………

15. Other Remarks:

………………………………………………………………………………………………………………
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………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

16. I do consider that he/she is PHYSICALLY FIT to be employed. His/her health is such that in my
Opinion it will not detrimentally affect performance of his/her duties.

Signed: …………………………… Appointment: ………………………………..

Date/Stamp: ………………………