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IIMU MBA 2020 A8 Medical Fitness Certificate

This document contains a medical fitness certificate template that must be completed by a medical authority no less than a Civil Surgeon for admission to an MBA program at IIM Udaipur. The certificate requires information on any medical conditions, vaccinations for typhoid, hepatitis A, hepatitis B, and chicken pox. The doctor must also provide identifying marks, signatures, registration number, and hospital information.

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Aayoush Gupta
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800 views1 page

IIMU MBA 2020 A8 Medical Fitness Certificate

This document contains a medical fitness certificate template that must be completed by a medical authority no less than a Civil Surgeon for admission to an MBA program at IIM Udaipur. The certificate requires information on any medical conditions, vaccinations for typhoid, hepatitis A, hepatitis B, and chicken pox. The doctor must also provide identifying marks, signatures, registration number, and hospital information.

Uploaded by

Aayoush Gupta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Annexure 8

(To be submitted at the time of registration)

Medical Fitness Certificate


Medical Fitness Certificate to be obtained from a competent medical authority not less than a Civil
Surgeon rank or equivalent. Please note that there is no facility in Udaipur to get the Medical Check-
up done.

Besides this, please note that participants must take i) Typhoid, ii) Hepatitis A, iii) Hepatitis B, and iv)
Chicken Pox vaccine either before arriving or immediately after arriving at the institute. Doctor’s
certificate needs to be produced to that affect.

Certificate
I hereby certify that I have examined Mr./Ms. ____________________________________________, a
candidate for admission to the Master of Business Administration program in Management at the Indian
Institute of Management, Udaipur for MBA 2020-22 Batch.

I cannot discover that he/she has any disease, constitutional affliction or bodily infirmity except
___________________________________________. I consider/do not consider (strike out whichever is not
applicable) this a disqualification for admission and studies at the Indian Institute of Management, Udaipur.

His/Her age, according to his/her own statement, is ___________ years and by appearance about _________
years.

Mr./Ms. __________________________________ has been vaccinated against the following on the


dates mentioned.

a) Typhoid Yes No If Yes, on

b) Hepatitis A Yes No If Yes, on

c) Hepatitis B Yes No If Yes, on

d) Chicken Pox Yes No If Yes, on

Mark(s) of Identification: ____________________________________________________________

______________________ ____________________________________
(Signature of the Candidate) (Signature of Civil Surgeon/ Assistant Civil
Surgeon/ Medical Officer)

Registration No._______________________

Seal of Hospital: Date: ___________________

Place: ___________________

Hospital Address: ________________________________________________________________

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