Appendix I/55
Concession for Heart Patients
APPENDIX I/55
(See Rules,101,Serial No.41)
CONCESSION CERTIFICATE
Form for the purpose of issue of Rail Concession to Heart Patients to

This is to certify that Shri/Shrimati……………………………………………………Whose particulars are furnished below ,is a bonafide Heart Patient and is required to travel alone or with escort from ………………………………………………………………… (Station) to ……………………………….(Station) on discharge after heart heart Operation at …………………………Hospital
Particulars of the Heart Patient
(a) Age
(b) Sex
Place ……………….. Signature ……………………..
Officer-in-charge of the Hospital
Date …………………
Seal of the Hospital
Indicate the name of the Hospital
Note (1) The Certificate is valid for three months from the date of issue
(2) No alteration in the form is permitted unless attested by the issuing officer.
(3) Certificate should be issued to heart patients only for travel from the station serving the Hospital to station serving his place of residence.