APPENDIX 'C'
(See Rule 101, Serial No.28)
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 TOTALLY DEAF AND DUMB PERSON.
  
Particulars of the Orthopaedically handicapped/ Paraplegic person/ patient
1. Address : ______________________________
2. Father's/ Husband's Name : ______________________________
3. Age : ______________________________
4. Sex : ______________________________
5. Signature of Left Hand Thumb Impression of deaf & dumb person : ______________________________
6. Causes of loss of functional capacity : ______________________________
      
      
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. Certificate should be issued only to TOTALLY DEAF & DUMB PERSONS (BOTH AFFLICTIONS TOGETHER IN THE SAME PERSON.) 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. 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 is accepted for 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 demanded.
  3. No alteration in the form is permitted.
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