Form 3 — CCS

FORM 3 (See Rule 19) MEDICAL CERTIFICATE FOR GAZETTED OFFICERS RECOMMENDED LEAVE OR EXTENSION OF LEAVE OR COMMUTATION OF LEAVE

Signature of the Government Servant……………………………………………….. I.........................................after careful personal examination of the case hereby certify that Shri/Shrimati/Kumari……………….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.

NOTE 1.—Deleted. Civil Surgeon / Staff Surgeon / Authorized Medical Attendant …………………..Dispensary NOTE 2.—This form should be adhered to as closely as possible and should be filled in after the signature of the Government servant has been taken. The certifying officer is not at liberty to certify that the Government servant requires a change from or to a particular locality or that he is not fit to proceed to a particular locality. Such certificates should only be given at the explicit desire of the administrative authority concerned to whom it is open to decide, when an application on such grounds has been made to him, whether the applicant should go before a 2[ Civil Surgeon/Staff Surgeon/Authorized Medical Attendant/to decide the question of his / her fitness for service.

NOTE 3.— No recommendation contained in this certificate shall be evidence of a claim to any leave not admissible to the Government servant.

FORM 3-A (See Rules 19 and 20) MEDICAL CERTIFICATE FOR GOVERNMENT SERVANTS WHO ARE TO BE RECOMMENDED LEAVE UNDER RULE 20

Signature / thumb impression of the Government servant…………………… Itis certified that Shri / Shrimati /Kumari.....................(designation and place of work may also please be indicated) is under my medical supervision since………………… and is suffering from............................................. *.