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Get IN Concession Certificate

Mr./Ms. ______________________________, whose particulars are furnished below, is a bonafide Kidney patient and is required to travel alone or with escort from _________________ (station) to ______________ (station) for *dialysis/Kidney transplant operation at __________________________ Hospital. Particulars of the Kidney Patient (a) (b) Age Sex Place _______________ Date ________________ Signature _________________ Officer in charge of the recognized Hospital Seal/Stamp of the Recognized h.

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