CONCESSION CERTIFICATE Paste passport Form for the purpose of grant of rail Size photograph concession t Mentally Retarded persons Duly signed and to be issued by Government Doctor Stamped by the Issuing doctor This is to certify that Kum./Shri./Smt. ______________________________ whose particulars are furnished below, is a bonafide Mentally Retarded person and Cannot travel without an escort. Particulars of the Mentally Retarded Person: a) Address _________________________________________________________ b) Father's /Husband's Name : c) Age d) Sex : e) Signature or Thumb impression of Mentally Retarded person _____________________________________ Place: (Signature of Government Doctor) Date ; Clear seal of Government Seal containing full name and Hospital / Clinic Reg. No. of the Doctor Note: 1) Certificate should be issued only to those Mentally Retarded persons Who cannot travel without 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) 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 propose 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 alternation in the form is permitted.
