FORM NO. III [See Rule 16] Certificate of fitness 1. Serial No. …………………………………… Serial No. …………………………
Date …………………………………………. Date………………………………..
2. Name …………………………. I certify that I have personally examined
(Name)
3. Father’s Name
…………………………………………………………………………
4. Residence …………………………….son of…………………………….
residing at…………………………………………….. 5. Date of birth if available…………………………………. and/ or
certified age………………………………………………….. 6. Physical fitness ……………………………………….. Who is desirous of
being employed in a motor transport undertaking and that his age, as nearly
or can be ascertained from examination
is…………………………………………………… 7. Descriptive marks ………………………………………………….. and that he is
…………………………………………………………….. fit for employment in
motor transport under taking as an adolescent.
8. Reasons for
(1) Refusal of certificate His descriptive marks are-
_______________________ ________________________________
_______________________ ________________________________
(2) Certificate being revoked
________________________ ________________________________
_______________________ ________________________________
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Initials of Certifying Surgeon Certifying Surgeon
Note- Exact details of cause of physical disability should be clearly stated.
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