CONCESSION CERTIFICATE CHANDIGARH ADMINISTRATIONPaste Passport size photographduly signed and stamped bythe Issuing Doctor / PersonForm for the purpose of grant of rail concessionto Mentally Retarded persons to be used by theGovernment DoctorThis is to certify that Km/Shri / Smtwhose particulars are furnished below, is a bonafide Mentally Retarded person and CANNOT TRAVEL WITHOUT THE ASSISTANCE OF AN ESCORT. PARTICULARS OF THE MENTALLY RETARDED PERSON :-(a) Address(b) Father's /Husband's Name(c) Age :(d) Sex MaleFemale(e) Signature or Thumb impression of Mentally Retarded person :Place :Date :(Signature of Government Doctor)Clear seal of Government Seal containing full name and Regn. Hospital / Clinic No. of the Doctor Note: 1) Certificate should be issued only to those Mentally Retarded Persons WHO CANNOTTRAVELWITHOUT 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) The certificate is Valid for a period of Five years from the date of issue. After expiry the period of validity of the certificate, the person is required to obtain a fresh certificate. A Photostat copy of t his certificate is accepted for the purpose of grant of concession. The original certificate will have to be produced for inspe ction at the time of purchase of confessional ticket and during the journey, ifdemanded. 3) No alteration in the form is permitted
