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Get Form B Medical Fitness Certificate

FORM B MEDICAL FITNESS CERTIFICATE See Section 7 8 and Section 12 of the Motor Vehicle Act 1989 Form of Medical Certificate in respect of an applicant for license to drive any transport vehicle or drive as a paid employee To bebe filled up by registered medical practitioner To filled up by a a registered medical practitioner - C. N*I. C. 1. What is the applicant s age 2. Is the applicant to the best of your judgment subject to epilepsy vertigo or any mental ailment likely to affect his efficiency 3. Does the applicant suffer from any heart or lung disorder which might interfere with the performance of his duties as a driver 4. a Is there any defect of vision If so has it been corrected by suitable spectacles b Can the applicant readily distinguish the pigmentary colours red and green would prevent his hearing the ordinary sound signals 5. Has the applicant any deformity or losses members which would interfere with the efficient performance of his duties as a driver 6. Does he show any evidence of being addicted to the excessive use of an alcohol tobacco or drugs 7. Is he in your opinion generally fit as regards a bodily health and b eyesight 8. Marks of identification In addition to the above questionnaire I certify that to the best of my knowledge and belief the applicant PHOTOGRAPH is the person here on above described and the attached photograph is a reasonably correct likeness Signature Name Designation Medical Licence No. N*I. C. 1. What is the applicant s age 2. Is the applicant to the best of your judgment subject to epilepsy vertigo or any mental ailment likely to affect his efficiency 3. Does the applicant suffer from any heart or lung disorder which might interfere with the performance of his duties as a driver 4. Does the applicant suffer from any heart or lung disorder which might interfere with the performance of his duties as a driver 4. a Is there any defect of vision If so has it been corrected by suitable spectacles b Can the applicant readily distinguish the pigmentary colours red and green would prevent his hearing the ordinary sound signals 5. a Is there any defect of vision If so has it been corrected by suitable spectacles b Can the applicant readily distinguish the pigmentary colours red and green would prevent his hearing the ordinary sound signals 5. Has the applicant any deformity or losses members which would interfere with the efficient performance of his duties as a driver 6. Has the applicant any deformity or losses members which would interfere with the efficient performance of his duties as a driver 6. Does he show any evidence of being addicted to the excessive use of an alcohol tobacco or drugs 7. Is he in your opinion generally fit as regards a bodily health and b eyesight 8. Does he show any evidence of being addicted to the excessive use of an alcohol tobacco or drugs 7. Is he in your opinion generally fit as regards a bodily health and b eyesight 8. Marks of identification In addition to the above questionnaire I certify that to the best of my knowledge and belief the applicant PHOTOGRAPH is the person here on above described and the attached photograph is a reasonably correct likeness Signature Name Designation Medical Licence No..

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