Advance Certificate
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ADVANCE CERTIFICATE
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(Certificate to be furnished by the Medical Officer under Rule 6)
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          Certified that Mr./Mrs./Miss. ________________ ________________Father/Mother/Husband/Wife/Son/ Daughter of Mr./Mrs./Miss.______________________ working as ______________ in the office of ________ ___________________________________________ is suffering from ______________________________ and that a sum of Rs. _________ ( Rupees_________ __________________________________________) on is Necessary as Advance to cover the Medical Expenses Reimbursement by Government in the case.
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Date:Signature and Designation of the Medical Officer In Charge of the Hospital
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Place:
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ADVANCE CERT.