Blind Rail Concession Form
| Blind Rail Concession Form
(Rule 101, Serial No.24)
| Paste passport size photograph Duly signed and stamped by the Issuing
|| For completely Blind persons to be used by a Regd. Medical
Practitioner/Government Doctor/Heads of the Institutions for the Blind recognized
by Ministry of Welfare/Govt. of India or Social Welfare Deptt. of the concerned
| This is to certify that Km./ Shri./ Smt. ..................................................,
whose particulars are furnished below, is a bonafide "Orthopaedically handicapped/Paraplegic
person/patient and IS COMPLETELY BLIND.
| Particulars of the Blind patient :
- Address :
- Father's/ Husband's Name :
- Age :
- Sex :
- Nature of handicap (To be written by Doctor whether the disability
is temporary or permanent) :
- Causes of loss of functional capacity :
- Signature or Thumb Impression of Blind person:
| Place :
Signature of Govt. Doctor
Clear Seal of Govt. Hospital/ Clinic
Seal Containing full name and Regd. No. of Doctor
| * Strike out where not applicable Note:
- The Certificate should be issued only to those COMPLETELY BLIND PERSONS.
The photo must be signed and stamped by the certificate issuing Doctor/person
in such a way that the signature and stamp appears partly on the photo
and partly on the certificate.
- The certificate is valid for five years from the date of issue. After
expiry of the period of validity of the certificate, the person is required
to obtain a fresh certificate. A Photostat copy of the certificate 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.
- No alteration in the form is permitted.