(TO BE SUBMITTED AT THE TIME OF COUNSELLING/ADMISSION)
I certify that I have carefully examined Shri/Km/Smt.*____________________________________________
son/daughter/wife of Shri/Smt.* __________________________________________________whose signature
is given below. Based on the examination, I certify that he/she is in good mental and physical health and is
free from any physical defects which may interfere with his/her studies including the active outdoor duties
required of a professional.
Visible Mark of Identification _____________________________________________
Signature of the Candidate__________________________________________
Name & Signature of the
Medical Officer with Seal
and Registration Number
*Strike whichever is not applicable.
** To be signed by a Registered Medical Practitioner holding a degree not below that of M.B.B.S.
Note: Blind (including colour blind), deaf and/or dumb candidates shall not be eligible for admission in Bachelor of Homeopathic Medicine and Surgery (BHMS).