Concession Certificate-Disabled Persons
APPENDIX 'A'
{See Rule 101 Sr.No.9(1)and (2)}
CONCESSION CERTIFICATE
Paste passport size Photograph duly signed and stamped by the issuing Doctor/Person
Form for the purpose of grant of rail concession to completely Blind persons to be used by a Regd. Medical Practitioner/ Government Doctor/Heads of the Institutions for the Blind recognised by Ministry of Social Justice & Empowerment /Govt. of India or Social Welfare Deptt. of the concerned State Government.
This is to certify that Km./Shri/Smt............................................................
whose particulars are furnished below, is a COMPLETELY BLIND PERSON.
Particulars of the completely blind person:
(a) Address:...................................................
(b) Father's/Husband's Name.......................................................
(c) Age:.............. Sex: ..........
(d) Signature or left hand Thumb:...........................(Impression of blind person)
Place:..........
Date:..........
(Signature of the Registered Medical Practitioner or Govt. doctor or Head of the Institution for the Blind, recognised by M/O Social Justice & Empowerment,Govt. of India or Social Welfare Deptt. of the concerned State Government)
Clear seal of Government Hospital/Clinic or Institution
Seal containing full name and Regd. No of the certificate issuing Doctor/Person
Certificate:
1. This certificate should be issued only to COMPLETELY BLIND PERSONS. The photo must be signed and stamped by the certificate issuing Doctor/person in such a way that signature and stamp appears partly on the photo and partly on the certificate.
2. The certificate is valid for five years from the date of issue. After expiry of the period of validity of the certificate, the person is required to obtain a fresh certificate. A Photostat copy of this certificate will have to be produced for inspection at the time of purchase of concessional ticket and during the journey If demanded,
(No alteration in the form is permitted.)
