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FORM 8: FIRST CERTIFICATE (CONFIDENTIAL) Regulations 57 and 89B Signature/thumb-impression of insured person.............................. Deposit this certificate within 3 days with local office to avoid possible loss of benefit under regulation 64 Book No ____________ Serial No ___________ 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 ______________ Date ____________ Signature ____________ Insurance Medical Officer (Rubber stamp or name in block letters) Any other remarks by the Medical Officer ________________________________ | |||||
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