M.P (Madhya Pradesh) Govt Leave Forms

M.P (Madhya Pradesh) Govt Leave Forms

for applying for the leave DOWNLOAD

Leave Medical Form 3 and 5

Leave EL_form

FORM-3

 

Signature of applicant : ……………………

Medical Certificate for Gazetted Officers recommended Leave or Extension of Leave or Commutation of Leave

(Govt. of India Finance Department No 173-S. R. Dated 17 March, 1931)

 

I ……………………………………………………..after careful personal examination of the case, hereby certify that Shri/Smt./Kum…………..… whose signature is given above is suffering from ………………………………………… and I consider that a period of absence from duty of ………… with effect from ………………….…  is absolutely necessary for the restoration of his/her health.

 

Dated:

 

Govt Medical Attendant

or

Registered Medical Practitioner   (No…………………)

 

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FORM – 4

 

Medical Certificate of Fitness to return of duty

 

Signature of applicant: ……………………

 

I ……………………………………………..  Civil Surgeon/Staff Surgeon,/Authorised Medical Attendant/Registered Medical Practitioner do hereby certify that we/I have carefully examined Shri/Smt./Kum…………………………………… whose signature is given above, and find that he/she has recovered from his/her illness and is now fit to resume duties in Govt. Service.  We/I also certify that before arriving at this decision we/I have examined the original medical certificates and statement(s) of the case (or certified copies thereof) on which leave was granted or extended and  have taken these into consideration in arriving at our/my decision.  He/Her is fit for duty with effect from …………………….…….

 

 

Dated:

 

 

Civil Surgeon/Staff Surgeon/

Govt. Medical Attendant/

Registered Medical Practitioner (No…………………)