CONCESSION CERTIFICATE Appendix No: 1/47
Paste passport size photograph duly signed and stamped by the issuing doctor
Form for the purpose of grant of rail concession to totally deaf & Dumb persons (both affictions
together in the same person) to be used by the Government Doctor

This is to certify that Km./Shri/Smt......................................Whose Particulars are furnished below, is a TOTALLY DEAF & DUMB PERSON.
Particulars of the totally deaf & dumb person:
(a) Address:................................................................................................................
(b) Father's/Husband's Name .....................................................................................
(c) Age .............................................. (d) Sex ..................................................
(e) Signature or left hand Thumb impression of deaf & dumb person.....................
..............................................
(Signature of Government Doctor)
Place ..............................
Date ..............................
................................................................. .......................................................
Clear seal of Government Hospital/Clinic Seal containing full name and
Regd.No. Of the Doctor
Note : (1) Certificate should be issued only to TOTALLY DEAF & DUMB PERSONS (BOTH AFFLICATIONS TOGETHER IN THE SAME PERSON ).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.