Appendix 1/17
Concession certificate
APPENDIX 1/ 17
Concession for cancer patients
Outward Journey

Form for the purpose of issue of Rail Concession to Cancer Patients
to be used by Officer-in -charge of the recognised Hospital/Institute
To
The Station Master,
---------------------(Station)
--------------------- ( Railway)
This is to certify that Shri/Shrimati , whose particulars are furnished below, is a bonafide Cancer patient and is required to travel from (Station) to ____ (station). The patient has secured admission for treatment/is travelling for periodically check up at + Cancer Hospital/Cancer Institute
(a) Age
(b) Sex
Station ---
Date ----
Seal/Stamp of the
Hospital/Institute
Particulars of the Cancer Patient
Strike out where not applicable.
+.Indicate name of the Hospital, etc.
Note:
Signature ----
Officer-in-charge of the Hospital / Institute
I. This certificate is valid for one year from the date of issue.
2. No alteration in this form is permitted unless attested by the issuing Officer
3. Certificate should be issued to patients only for travelling from the station serving his place of residence to the station serving the Hospital/ Institute.
Appendix 1/18
Concession certificate

APPENDIX 1/18
Concession for cancer patients
Return Journey

Form for the purpose of issue of Rail Concession to Cancer
Patients used by the Officer-in -charge of the recognised Hospital/Institute

The Station Master,
This is to certify that Shri/Shrimati , whose particulars are furnished below, is a bonafide Cancer patient required to travel from (Station) to ____ (station) on discharge from/after re-examination/periodical checkup at _____ £. Cancer Hospital / Cancer Institute.
Particulars of the Cancer Patient
(a)
(b)
(c)
Age
Sex
Personal identification marks
(d) Signature or left hand thumb
lmpression of the patient
Station - --
Date ----
Seal/Stamp of the
Hospital / Institute
Strike out where not applicable.
£. Indicate name of the Hospital, etc
Note:
(!) ____
(2) ____
Officer-in-charge of the
Cancer Hospital/ Institute
I. This certificate is valid for three months from the date of issue.
2. No alteration in this form is permitted unless attested by the Issuing Officer.
3. Certificate should be issued to patients only for travelling from the station serving the
hospital/Institute to the station serving his place of residence.