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

This is to certify that Mr./Ms , whose particulars are furniShed below, is suffering from Sickle cell Anaemia and is required to travel from -:---- (station) to (station) for treatment at ______ Hospital.
Particulars of the Sickle cell Anaemia patient
(a) Age
Plac;e ___
Date ____
SeaVStamp of the
Govt. Recognized Hospital
(b) Sex
Signature, Name & Stamp of Officer-in-charge of
the Government recognized hospital issuing this
certificate
Indicate name of the Hospital, etc
Notf!: 1. This certificate is to be issued by Officer in-charge of the Government
Recognized Hospital where the above named patient is to be treated. This should
be issued to only those patients who are to be treated Sickle cell 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
pathmt'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 Sickle cell Anaemia patients to be used by Officer-in -charge of the Government recognized Hospital

This is to certify that Mr./Ms , whose particulars are furnished below, is suffering from Sickle cell Anaemia and is required to travel from ____ (Station) to (station) after treatment at Hospital.
Particulars of the Sickle cell Anaemia Patient
(a) Age
SEtaVStamp of the Govt. Recognized Hospital
(b) Sex
Signature, Name & Stamp of Officer-in-charge of the Government recognized hospital issuing this certificate
lndicate name of the Hospital, etc
Note: 1. This certificate is to be issued by Officer in-charge of the Government Recognized Hospital where the above named patient has been treated. This should be issued to only those patients who have been treated for Sickle cell 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.