CONCESSION CERTIFICATE
Appendix No: 1/13
Paste passport size photograph duly signed and stamped by the issuing doctor/person
Form for the purpose of grant of rail concession to completely Blind person be used by a Regd. Medically Practicion government Doctor/Heads of the Institutions for the Blind recognised by Minis. of Welfare / Govt.of India or Social Welfare Dept.of the concerned State Government

This is to certify that Km./Shri/Smt......................................Whose Particulars are furnished below, is a COMPLETELY BLIND PERSON.
Particulars of the completely Blind person:
(a) Address:................................................................................................................
(b) Father's/Husband's Name .....................................................................................
(c) Age .............................................. (d) Sex ..................................................
(e) Signature or left hand Thumb impression of blind person.....................
..........................................................................
(Signature of Regd. Medical Practitioner or Govt.
Doctor or Head of the Institution for the blind
recognised by M/O Welfare ,Govt.of India or
Social welfare Dept.of the concerned State Government.)
Place ..............................
Date ..............................
................................................................. .......................................................
Clear seal of Government Hospital/Clinic Seal containing full name and
or Institution Regd.No. of the certificate issuing Doctor/Person
Note : (1) Certificate should be issued only to COMPLETELY BLIND PERSONS. The photo should must be signed and stamped in such a way that Doctor's signature and stamp appears partly on the photo and partly on the certificate.
(2) The Certificate is valid for five years from the date of issue.After expiry period of validity period of the certificate.the person is accepted for the purpose of grant of concession.The original certificate will have to be produced for inspection at the time of purchase of concessional ticket and during the journey,if demanded.
(3) No alteration in the form is permitted.