Concession Certificate (for Outward Journey)
Form for the purpose of issue of Rail Concession to Kidney 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 a bonafide Kidney patient and is required to travel alone or with escort from _________________ (station) to ______________ (station) for dialysis/Kidney transplant operation at __________________________ Hospital.
Particulars of the Kidney Patient
(a) Age
(b) Sex
Place _______________ Signature _________________
Date ________________ Officer in charge of the recognized Hospital
Seal/Stamp of the Recognized hospital
delete not applicable
NOTE:
1. This certificate should be issued by Officer in-charge of the Recognized Hospital where the kidney patient is being treated.
2. The certificate is valid for three months from the date of issue.
3. No alteration in the form is permitted.
4. Certificate should be issued to Kidney patients only for traveling from the station serving his place of residence to the station serving the Hospital.

Concession Certificate (for return Journey)
Form for the purpose of issue of Rail Concession to Kidney 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 a bonafide Kidney patient and is required to travel alone or with escort from _________________ (station) to ____________________________(station) for dialysis/Kidney transplant operation at ___________________________Hospital.
Particulars of the Kidney Patient
(c) Age
(d) Sex
Place _______________ Signature _________________
Date ________________ Officer in charge of the recognized Hospital
Seal/Stamp of the Recognized hospital
* delete not applicable
NOTE :
1. This certificate should be issued by Officer in-charge of the Recognized Hospital where the kidney patient is being treated.
2. The certificate is valid for three months from the date of issue.
3. No alteration in the form is permitted.
4. Certificate should be issued to Kidney patients only for traveling from the station serving his place of residence to the station serving the Hospital.