TRM2 (Note A to Item XI of Part A of Annexure I to Chapter 8) Form of certificate to be issued by a medical practitioner nominated by Indian mission etc. abroad MEDICAL CERTIFICATE I hereby certify that I have personally examined ______________________________________ (Name - Block letters) ______________________________________________________________________________ _____________________________________________________________________________ (address) and he/she is suffering from ______________________________________________________ _____________________________________________________________________________ (ailment). I recommend that he/she und rgoes immediate medical treatment for which he/she will be required to stay for about ______ days in ___________________________________________ (Name of the country) The cost of the medical treatment will be approximately________________________________ _____________________________________ Place: ................ (Signature of Medical practitioner) Date: ................. Name ____________________________ Designation ____________________________ Registration No.____________________________ Address ____________________________ ____________________________
