APPENDIX 'B'
(Rule 101, Serial No.25)
CONCESSION CERTIFICATE
Paste passport size photograph Duly signed and stamped by the Issuing Doctor Form the purpose of grant of rail concession to Orthopaedically Handicapped/ Paraplegic persons/ patients to be used by the Govt. Doctor
This is to certify that Km./ Shri./ Smt. .................................................., whose particulars are furnished below, is a bonafide "Orthopaedically handicapped/Paraplegic person/patient and CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORT.
  
Particulars of the Orthopaedically handicapped/ Paraplegic person/ patient
1. Address : ______________________________
2. Father's/ Husband's Name : ______________________________
3. Age : ______________________________
4. Sex : ______________________________
5. Nature of handicap (To be written by Doctor whether the disability is temporary or permanent) : ______________________________
6. Causes of loss of functional capacity : ______________________________
7. Signature or Thumb Impression of Orthopaedically handicapped/ Paraplegic person/ patient (not necessary for those whose both hands are missing or non-functional) : ______________________________
      
      
Place : __________ Signature of Govt. Doctor
Date : __________  
    
    
_________________________ _________________________
Clear Seal of Govt. Hospital/ Clinic Seal Containing full name and Regd. No. of Doctor
    
* Strike out where not applicable  
    
Note :-  
  1. The certificate should be issued only to those Orthopaedically Handicapped/ Paraplegic persons/ patients WHO CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORT. The photo must be signed and stamped in such a way that Doctor's signature and stamp appears partly on the photo and partly on the certificate.

  2. In the case of temporary disability, the certificate will be valid for five years from the date of issue. In the case of permanent disability, the certificate will remain valid for (1) five years, in case of persons upto the age of 25 years, (2) ten years, in case of persons in the age group of 26 to 35 yearsw and (3) in the case of persons above the age of 35 years, the certificate will remain for whole life of the concerned person. After expiry of the period of validity of the certificate, the person is required to obtain a free certificate. A photostat copy of this certificate is accepted for the purpose of grant concession. The original certificate will have to be produced for inspection at the time of purchase of concessional ticket and during the journey, if demanded.
  3. No alteration in the form is permitted.
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