FORM 8: First Certificate
(CONFIDENTIAL)
[Regulations 57 and 89B]
49[Signature/thumb-impression of insured person…………………………]
50[Deposit this certificate within 3 days with local office to avoid possible loss of benefit under regulation 64]
Book No ____________
Serial No ___________
51[Employer’s Code No.]
Insurance No _____________
Stamp of dispensary ________
I certify that I have examined you today and that in my opinion you now need medical treatment and attendance and abstention from work on medical grounds by reasons of ________
*In my opinion you will be fit to resume work tomorrow / on 52[______________]
Date ____________
Signature ____________
Insurance Medical Officer
(Rubber stamp or name in block letters)
Any other remarks by the Medical Officer ________________________________
