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This form is to be used by every and who date is require by the Andhra Pradesh public service
commission to produce certificate of physical fitness it must be signed by a commissioner
medical officer or a civil medical officer or rank not lower then that of a civil surgen A district
medical officer employes under Andhra Pradesh government
Note :A candidate outside the Andhra Pradesh state whose unable produce the certificate from
medical officer employed in Andhra Pradesh state may be produce it from a medical office of a
corresponding rank out side the A.P. state such certificate should containing the following
particulars.
1. The state under which the medical officer is employed and the name of the institution in
which as employed and his rank
2. Register number of certificating medical officer in the register in which his name has
been registered
3. The official stamp of the institution on which the certificating medical officer is
employed the certificates produce will be subject to acceptance after security by the
director of medical service Andhra Pradesh
I do further certify that in my opinion his general physical condition is such as to unable him
erforin efficiently the active duties of executive service
hyper metropic
(here enter the degree of and defect the strength correction glasses)
Myopiei (
(here enter the degree of and defect strength of correction glasses) aring is normal
defective (Much or slight )
Does chemical examination shown (i) albument (ii) sager state state specific gravity
personal make at last show should be mentioned
signature
STATION rank
DATE Designation
The candidate must make the statement required below prior to his medical examination and
must sign the declaration append there to the presence medical office his attention is specially
directed to the warin contained in the note below
I declare all than answer to be to the best of my belief true and corect
I also truly affirm that I have not received at disability certificate / person on
Candidate signature
Signature in presence
Signature of medical officer
Note 1. the candidate will be held resports belrs the accurancy of the above statement by willfully
appearing any information he will into the rank of loosing the appointment and of appointed of
for set in all claims to supervation allowance of graduty
2 .the candidate selected by commissions for direct retirement to the Andhra Pradesh police
service of recurired to Andhra Pradesh civil executive branch other wise than from Andhra
Pradesh revenue subordinate service will be examined a medical board before appointment