here it is, this may fulfil your purpose. please copy-paste the form to your
word processor and choose the page setup which fits your need.
(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 orthopedically
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 deaf and dumb 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 : _________
Date : __________ Signature of Govt. Doctor
____________________________________
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 deaf and dumb
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.
----- Original Message -----
From: "Amiyo Biswas" <[email protected]>
To: <[email protected]>
Sent: Thursday, August 18, 2011 12:31 PM
Subject: Re: [AI] About Railway Concession Again.
I need it for an orthopaedically handicapped person now. Still I would
prefer the details for other categories if available. I receive requests
for such information very frequently.
With best regards,
Amiyo Biswas.
Cell: 9433464329
----- Original Message -----
From: "BHAWANI SHANKAR VERMA" <[email protected]>
To: <[email protected]>
Sent: Thursday, August 18, 2011 7:42 AM
Subject: Re: [AI] About Railway Concession Again.
are you talking about concessions for multiple handicapped or other
disabilities then visual.
----- Original Message -----
From: "Amiyo Biswas" <[email protected]>
To: <[email protected]>
Sent: Thursday, August 18, 2011 6:41 AM
Subject: [AI] About Railway Concession Again.
Hello,
I am sorry that I am repeating the question. Is there any circular or
document on concession in fair to visually impaired and other categories
of handicapped travellers? What are the provisions?
With best regards,
Amiyo Biswas
Cell: +91-9433464329
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