This document is a communication from the Department of Personnel and Training, Ministry of Personnel, Public Grievances & Pensions, Government of India, to the Chief Medical Officer of Dr. RML Hospital. It directs the medical examination of candidates recommended for appointment to the Stenographer Grade ‘D’ of the Central Secretariat Stenographer Service (CSSS) based on the 2017 examination results. The document includes details regarding the examination schedule, location (OPD Block, Dr. Ram Manohar Lohia Hospital, New Delhi), and a request for the medical results to be submitted in the prescribed form. It also contains the prescribed medical certificate and candidate declaration forms to be completed during the examination. An annexure lists the candidates, their roll numbers, and ranks.
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No. 6/1/2019-CS-II(C)
Government of India
Ministry of Personnel, Public Grievances & Pensions (Department of Personnel and Training)
$3^{\text {rd }}$ Floor, Lok Nayak Bhavan Khan Market, New Delhi
Dated: 27 th May, 2019
To
The Chief Medical Officer \&
Officer-in-Charge (Medical Examination-I)
Dr. RML Hospital, New Delhi-110001
Subject: Medical Examination of candidates for appointment to the Grade of Stenographers Grade ‘D’ of CSSS on the basis of the result of Stenographers Grade ‘C’ \& ‘D’ Examination 2017.
Sir/Madam,
I am directed to refer to the subject mentioned above and to say that the candidates recommended for appointment to the grade of Stenographer Grade ‘D’ of Central Secretariat Stenographer Service (CSSS) in Government of India, on the basis of Stenographers Grade ‘C’ \& ‘D’ Examination 2017 are required to appear before Medical Board for their medical examination.
2. The candidates have been instructed to appear before you for medical examination at 8:00 AM in OPD Block, Dr. Ram Manohar Lohia Hospital, New Delhi for the date of medical examination before 14.06.2019. List of the candidates have been enclosed herewith. It is requested that the official may be medically examined and the result be intimated to this Department in the prescribed form.
3. The signature of the candidate may please be obtained on the prescribed form in your presence.
Yours faithfully
(Dinesh)
Under Secretary to the Government of India
Tele: 24654020
| S.No. | Name (Sh./Smt./Ms.) | Roll No. | Rank |
|---|---|---|---|
| 1 | SARTHAK PATHAK | 2201044685 | 38 |
| 2 | SHALINI | 2201004654 | 43 |
| 3 | VIKAS KUMAR YADAV | 2201028441 | 45 |
| 4 | AKSHAY TOMAR | 2201015610 | 75 |
| 5 | MAYANK SHARMA | 2201010080 | 79 |
| 6 | SAUDAMINI SHARMA | 2201007079 | 115 |
| 7 | VIPUL BHAGAT | 2201037187 | 128 |
| 8 | JAYA CHAUDHARY | 2201045988 | 208 |
| 9 | SUMIT | 2201001150 | 290 |
| 10 | VIJAY KUMAR | 2201002261 | 1272 |
| 11 | NEETU | 2201062980 | 1295 |
FORM OF MEDICAL CERTIFICATE
I hereby certify that I have examined $\mathrm{Sh} / \mathrm{Smt} / \mathrm{Ms}$. candidate for employment in the Central Secretariat Stenographer Service in the Government of India and cannot discover that he/she has any disease (communicable or otherwise), constitutional weakness or bodily infirmity, except $\qquad$ .
I do not consider this a disqualification for employment in Central Secretariat Stenographer Service in the Government of India.
The age of Shri/Smt./Ms. $\qquad$ according to his/her own statement is $\qquad$ years, and by appearance is about years.
(Signature/thumb impression
of the candidate)
Date $\qquad$
(To be signed in the presence of the examining Medical Officer)
Signature of Medical Officer
Name $\qquad$
Address $\qquad$
Official Seal
(Seal should be spread over
form and the photograph)
Note: The officer making this certificate should be a Civil Surgeon or a District Medical Officer of equivalent status of a Government Hospital
CANDIDATE’S STATEMENT AND DECLARATION
(The candidate must make the following statement and must sign the declaration below it before the medical officer. Attention is specially invited to the WARNING in the ‘Note’ at the bottom of page 2.)
- Name in full (in BLOCK letters)
-
Age and place of birth
-
Have you ever had (a) small-pox, intermittent fever and other fever, enlargement, suppuration of glands, spitting of blood, fainting attacks, rheumatism or appendicitis? OR (b) any other disease or accident requiring confinement to bed and medical or surgical treatment?
-
When were you last vaccinated?
-
Have you or any of your relatives been afflicted by consumption, scrofula, gout, asthma, fits, epilepsy or insanity?
-
Have you suffered from any form of nervousness due to overwork or any other cause?
-
Have you been examined and declared fit for Govt. Service by a medical officer/ Medical Board within the last three years?
-
Pursuant to the following particulars:
| Father’s age, if living, & state of health | Father’s age at the time of death and cause of death | No. of brothers living, their ages and state of health | No. of brothers who have died, their ages at death and cause of death |
|---|---|---|---|
Contd……/
| Mother’s age, if living, $k$ state of health |
Mother’s age at the time of death and cause of death |
No. of sisters who living, their ages and state of health |
No. of sisters who have died, their ages of death and cause of death |
|---|---|---|---|
DECLARATION
I declare that all the above answers are true and correct to the best of my knowledge and belief. I also solemnly affirm that I have not received any disability certificate/ pension on account of any disease or other condition.
Candidate’s signature
Date: $\qquad$
Signed in my presence.
Signature of Medical Officer
Name: $\qquad$
& Designation: $\qquad$
Note: The candidate will be held responsible for the accuracy of the above statement. By wilfully suppressing any information he will incur the risk of losing the appointment and, if appointed, of forfeiting all claims to superannuation allowance or gratuity.