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Age Certificate

This document is a medical certificate issued by a registered medical practitioner to certify an individual's age based on their statement and appearance. It includes spaces for the applicant's signature or thumb impression, the practitioner's details, and the purpose of the certificate. The certificate must be signed and sealed by the medical officer or authorized practitioner.

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Rhythms Kalyan
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18K views1 page

Age Certificate

This document is a medical certificate issued by a registered medical practitioner to certify an individual's age based on their statement and appearance. It includes spaces for the applicant's signature or thumb impression, the practitioner's details, and the purpose of the certificate. The certificate must be signed and sealed by the medical officer or authorized practitioner.

Uploaded by

Rhythms Kalyan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MEDICAL CERTIFICATE TO PROVE AGE

(To be signed by a registered medical practitioner)

Signature / thumb (Left) impression of applicant .. .. .. .. .. .. .. .. .. .. .. .. … … .. ..


I Dr. .. .. .. .. .. .. .. .. .. .. .. .. … … .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. … do hereby
certify that I have examined Shri / Smt. .. .. .. .. .. .. .. .. .. .. .. .. … … .. .. .. .. .. .. .. .. .. .. .. .. .. ..
… … .. .. .. .. .. .. .. .. .. .. .. .. .. .. … … .. .. (name and address) whose signature / left thumb
impression is given above, and found that his / her age according to his / her own statement is
….. … … .. .. .. .. years and by appearance about … … … … … … … … … … … … … … ..
.. .. .. .. .. .. .. .. .. .. .. … years.
This certificate is issued to be produced at .. .. .. .. .. .. .. .. .. .. .. .. … … .. .. .. .. .. .. .. .. .. .. .. ..
.. .. … … .. .. for .. .. .. .. .. .. .. .. .. .. .. .. … … .. ..

Signature of Government
Medical Officer / Civil Surgeon
/ Staff Surgeon/Authorized
Place Medical Attendant / Registered
Medical Practitioner
Date
Office seal

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