Paste Passport size Photograph duly Signed and Stamped by the Issuing Doctor

CONCESSION CERTIFICATE
Appendix-1/36 (See rule 101, Sl.No.25)

Form for the purpose of grant of rail concession to orthopaedically Handicapped/paraplegic persons/patients to be used by the Government Doctor. This is to certify that Sri/Smt Whose particular are furnished below, is a bonafied orthopaedically Handicapped /paraplegic persons /patients and CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORT) Particular of the orthopaedically Handicapped /paraplegic persons /patients: A) Address........ ................................................................................................................................... B) Fathers/Husbands Name.. C) Age. d) sex.

E) Nature of handicap (to be written by Doctor whether the disability is Temporary or permanent) . F) cause of loss of functional capacity G) Signature or left hand thumb Impression of orthopaedically Handicapped /paraplegic Persons /patients (Not. necessary for those whose both hands are missing or non functional) Place.. Date
.

.. (Signature of the Govt. Doctor)

Seal of Govt. hospital/clinic

(Seal containing full name and Reg. no of Doctor)

Note: 1. The certificate should be issued only to completely blind person. The photo must be signed and stamped by the
certificate issuing Doctor/person in such a way that signature appears partly on the photo and partly on the certificate. 2. The certificate valid for five years from the date of issue. After expiry period of validity of the certificate the person is requested to obtain a fresh certificate. Photography of this certificate is accepted from the purpose of grant of concession. The original certificate will have to be produced for inspection at the time of purchase of concessional ticket and during the journey, if desired. 3. No alteration in the, form is permitted.