APPENDIX 1/43 (CONCESSION FOR NON-INFECTIONS
LEPROSY (PATIENTS)
-----------------------------------
(Rule 101, Serial No.26)

Form for the purpose of issue of rai concession to leprosy patients to be used by officer – in – Charge of Leprosy Hospital / Clinic Institution

The Station Master,
------------------------
------------------------
This is to certify that Shri / Shrimati____________________________________________
whose particulars are furnished below is a bonafide Leprosy Patient and is required to travel from _______________ (Station) To_____________________________________ (Station) on discharge from / after re-examination / periodical check up at ________________________ Leprosy Hospital / Clinic / Institution and is entitled to concession in rail fare.
Particulars of the Leprosy Patient :-
(a) Age :
(b) Sex :
(c ) Personal identification Marks (1) _______________________________________
(2)_______________________________________
(d) He/She is suffering from infections/Non-infection Leprosy.
Station _________________
Date __________________
SEAL OF THE HOSPITAL
CLINIC/Institution. ______________________
(Signature)
Office-in-Charge of the Leprosy Hospital / Clinic / Institution
Strike out where not applicable
Indicate name of the Hospital .etc
for concession to patients of infections leprosy see Rule 149(3)
Vol.-1
Note :1. The certificate is valid for three months from the date of issue.
2.No alteration in the firm is permitted unless attested by the issuing officer .
3.Certificate should be issued to the patients only for travelling from stations serving his place of residence to and from the stations serving the Hospital/Clinic/Institution.