MEDICAL CERTIFICATE FOR LEAVE OR EXTENSION OF LEAVE

Signature or Thumb Impression of Patient/Applicant _____________________________________

(To be signed by the applicant in the presence of the Government Medical Attendant or Medical Practitioner)

I, Dr._________________________________________, Registered Medical Practitioner, after careful examination of the case certify hereby that Smt. _____________________________ Whose signature is given above is pregnant in her ______trimester period and I consider that a period of absence from duty for ________ days with effect from _______________________, is absolutely necessary to take care of her and her babys health which is due in the _________ Week of __________________(as per medical records available)

I, Dr. ________________________________________, after careful examination of the case certify hereby that Smt._________________________ on restoration of health is now fit to join service.
Note: Any recommendation contained in this certificate shall not be evidence of a claim to any leave not admissible to the Government servant under the terms of his/her contract, or of the rules to which he/she is subject to.

Date: Place:

Registered Medical Practitioner Registration No.

Rule 1 01 (a) of The Fundamental Rul es of the Tami lnadu Government