Concession certificate
(for outward journey)
Form for the purpose of issue of Rail Concession to Aplastic Anaemia patients to be
used by Officer-in-charge of the recognized Hospital

This is to certify that Mr./Ms , whose particulars are furnished below, is suffering from Aplastic Anaemia and is required to travel from ___ {station} to {station) for treatment/periodical check-up at £.
-----Hospital.
Particulars of the Aplastic Anaemia patient
(a) Age
SeaVStamp of the
·Recognized Hospital
(b) Sex
Signature. Name & Stamp of Officer-in-charge
of recognized hospital issuing this certificate
£. Indicate name of the Hospital, etc
Note: 1. This certificate is to be issued by Officer in-charge of the Recognized Hospital where the above named patient is to be treated. This should be issued to only those patients who are to be treated Aplastic Anaemia .
2. This certificate is valid for three months from the date of issue.
3. No alteration In the certificate is permitted.
4. This certificate is to be issued for outward journey from the station serving the
patent's place of residence to the station serving the Hospital.
..............................................................

Concession certificate (for return Journey)
Form for the purpose of issue of Rail Concession to Aplastic Anaemia
patients to be used by Officer-in -charge of the recognised Hospital
This is to certify that Mr./Ms , whose particulars are furnished below, is suffering from Aplastic Anaemia and is required to travel from _____ (Station) to (station) after treatment at Hospital.
Particulars of the Aplastic Anaemia Patient
(a) Age
Se;:~~I/Stamp of tf)e
Recognized Hospital
(b) Sex
Signature; Name & Stamp of Officer-in-charge
of recognized hospital issuing this certificate
£. Indicate name of the Hospital, etc
Note: 1. This certificate is to be issued by Officer-in-charge of the Recognized Hospital where the above named patient has been treated. This should be issued to only those patients who have been treated for Aplastic Anaemia .
2. This certificate is valid for three months from the date of issue.
3. No alteration in this certificate is permitted.
4. This certificate is to be issued for return journey from the station serving the Hospital to the station serving the patient's place of residence.