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Medical Certificate

1. The document is a medical certificate of fitness form to be filled out by a candidate and their doctor for employment consideration at TCS. 2. It requests personal and medical history information from the candidate, including any physical/mental illnesses or operations. 3. The candidate declares that the information is true and consents to TCS obtaining further medical information. The doctor examines the candidate and declares if they are medically fit for TCS employment.

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656 views2 pages

Medical Certificate

1. The document is a medical certificate of fitness form to be filled out by a candidate and their doctor for employment consideration at TCS. 2. It requests personal and medical history information from the candidate, including any physical/mental illnesses or operations. 3. The candidate declares that the information is true and consents to TCS obtaining further medical information. The doctor examines the candidate and declares if they are medically fit for TCS employment.

Uploaded by

lekaca
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Medical Certificate of Fitness

Please fill in the complete form, sign it and hand over to your Induction Coordinator
To be filled by Candidate
Candidate’s Personal Details:
Please affix a
Mr./Mrs./Ms./Miss/Dr. First Name: Last Name: Passport size
photo here and

Gender: Male Female Date of birth (DD/MM/YY) / / get it attested by


your consulting
Contact No: (M) (R) Blood Group: doctor

Candidate’s Medical History:


Candidate’s Medical Details Yes No Please provide the details
Do you suffer from any defect of vision?
If Yes, has it been corrected by suitable spectacles?

Can you readily distinguish between the pigmentary colors, Red and Green?

Do you suffer from a degree of deafness which would prevent your hearing
of normal conversation and ordinary sound signals?
Do you have any physical deformity / handicap or use any mechanical /
physical assistance for mobility?

Do you have any congenital disorder / abnormality?


Have you ever been diagnosed to have any Psychiatric ailment including
Depression, Anxiety Neurosis, Phobic Disorders, Schizophrenia, Manic
Depressive Psychosis or any other Psychiatric illness?

Have you had any form of critical illness or operation in the last two years?

Have you ever been disqualified on medical grounds from any previous
employment opportunity?
Have you ever been diagnosed with or do you suffer from any other Medical
condition that may require you to take Medical Leave over the next 12
months?
Have you ever been diagnosed to have Cancer, Tumor, Cyst or any similar
type of growth?
Have you ever been diagnosed with an alcohol or drug abuse problem? If
yes, are you on treatment for the same?

Have you ever suffered or suffering from any of the following? (Please () tick wherever applicable and provide necessary details.)
Valve Disorders High Blood Pressure Stroke
Heart Attack Diabetes Tuberculosis
Angina Pectoris Asthma Slipped disc
Arthritis Obesity Epilepsy
Night Blindness Hepatitis B Hepatitis C

TCS Confidential Candidate’s Signature Page | 1


Candidate’s Declaration:
I declare that to the best of my knowledge, the answers to the questions in this form are correct and that I am not suffering from any
disease/illness, the presence of which I have not revealed. I fully understand that any misrepresentation of this declaration could lead
to the termination of my offer/appointment. I have no objection to Tata Consultancy Services Ltd. seeking further information either
directly from me or from my Consulting doctor or other appropriate doctor. In case of any discrepancy arising out of my declaration, I
will be undergoing the medical check-up by the Company’s suggested medical clinic/doctor and their findings will be fully binding on
me and any action thereon towards my employment will be accepted by me.

Signed: Date: (DD/MM/YY) / /

The Candidate needs to ensure that a legally qualified and registered medical practitioner with minimum qualification as M.B.B.S.
completes this form. Additional sheets may be attached if more space is required.
Note: The candidate is responsible for any costs associated with the preparation of this report.

To be filled by Medical Practitioner


Doctor’s Details:
Full name (as listed on applicable state registry)

Registration ID: Contact No: (Day time)

Postal Address:

Doctor’s General Examination Remarks:


Weight: (Kgs) Height: (cms) Blood Pressure: (mm hg)

Pulse: (min) BMI (Calculated Value):

General Examination Findings:

Systemic Examination - CVS/RS/Abd/CNS/Others:

Doctor’s Declaration:
I, certify that I have carefully examined Mr./Mrs./Ms./Miss/Dr son/daughter of Mr.

. He/she is medically fit/unfit for employment with TCS.

Remarks:

Signed & Sealed: Date: (DD/MM/YY) / /

TCS Confidential Page | 2

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