Joint Seat Allocation Authority (JOSAA) Certificate Format and Download
Joint Seat Allocation Authority is conducting Admission and eCounselling Services and as part of the preparation and requirements, students need to produce a medical certificate for the counseling. We present you with the latest template of medical certificates which should be used by the students. Wish you all the best and good luck with your JOSAA counseling sessions.
Form-Il
Disability Certificate
(In cases of amputation or complete permanent paralysis oflimbs and in cases ofblindness)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE
CERTIFICATE)
(See rule4)
Date:
Certificate No.
This is to certify that I have carefully examined Shri/Smt./Kum...............................
son/wife/daughter of Shri............................... Date of Birth (DD/MM/YY)........................
Age................. years, male/female......................Registration No....................
permanent resident of House No...............Ward/Village/ Street...................Post Office.............
District..............State..................whose photograph is affixed above, and am satisfied that:
l. he/she is a case of:
a. locomotor disability
b. blindness
(Please tick as applicable)
2. the diagnosis in his/her case is................................
3. He/ She has...................... % (in figure)................... percent..............(in words) permanent physical impairment/blindness in relation to his/her .....................(part of the body) as per guidelines (to be specified).
4. The applicant has submitted the following document as proof of residence:=
Nature of Document| Date of Issue |Details of authority issuing certificate
(Signature and Seal of Authorised Signatory of notified Medical Authority)
Signature/Thumb impression of the person in whose favor the disability certificate is issued.
Disability Certificate
(In cases of multiple disabilities)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE
CERTIFICATE)
(See rule 4
