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Medical fitness form

Medical fitness form

Name: Medical fitness form

File size: 294mb

Language: English

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Confidential. Serial No. of Medical Certificate/Declaration of unfitness: Form for assessment of medical fitness. Regulations of 5 June No. on medical. 1. CERTIFICATE OF PHYSICAL FITNESS. (To be filled by a Registered Medical practitioner in the applicant's country of domicile). Name of Applicant. Signature of Government Medical Officer /Civil Surgeon /. Staff Surgeon/ Authorized Medical Attendant/Registered. Medical Practitioner alongwith official seal.

CERTIFICATE OF MEDICAL FITNESS. The certificate must be from the Medical Officer or any rank above it from any. Central/State Government. CERTIFICATE OF MEDICAL FITNESS. [To be obtained only from Gazetted Government Medical Officer / Medical Officer of a Government. Undertaking. ( Please. 1 Nov You can use this form to complete a self declaration of your medical Download ( KB).

SELF DECLARATION OF MEDICAL. FITNESS. Marine Safety (Domestic Commercial Vessel) National Law Act Marine Order (Certificate of. If you are in any doubt as to your fitness, talk to your doctor before the examination. 2. For the Medical Practitioner (Part B). a) This form is to be completed by the. Certificate of Medical Fitness – Seafarers. Please indicate with an X whether this certificate is for an STCW or a national certificate of competency or proficiency. PHYSICAL EXAMINATION FOR MEDICAL FITNESS CERTIFICATE General Examination: Height______ Weight ______ Physical Deformity (if any) ___. MEDICAL CERTIFICATE. [See Rule (1) (a)(d) and Declaration made by the applicant in Form-1 as to his physical fitness is attached. CERTIFICATE OF.

may affect my fitness? 7. When should I renew my medical certificate? 8. ENG 1 Medical Certificate. 9. ML5 Medical Certificate. Further reading. 2. 34 of , concerning minimum medical fitness standards in merchant ships as equivalent to Medical This form shall be competed in BLOCK CAPITAL letters. Medical Fitness form(to be completed in your country and submitted during enrollment in IIT Madras). 1. Full Name .. *2. This service enables customers to reprint medical fitness form 2. All Medical fitness customer who lost his/her request are eligible to apply for this service. 3.

Form for assessment of medical fitness. Serial No. of Medical Certificate. / Declaration of unfitness. Confidental. FOR version. Page: 1 of 5. Please review the list of medical signs, symptoms and conditions below. MEDICAL CONDITIONS. Respiratory: Allergies which affect respiratory system. To be obtained only from Gazetted Government Medical Officer/Medical Officer of a. Government Undertaking. (Please note that in no other form this certificate. I have examined the seafarer above and have found him/her to be free from any medical condition likely to be aggravated by service at sea, or to render the.


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