| . | .. | Medical Certificate for the Deaf
Certified that I, Dr.
………………………………………………………… Registration
No…………………………………………..
have this…………………………… Day of
…………………………………….19
examined the candidate whose particulars are given below. 1. Name of candidate 2. Father ‘s name
3. Sex
4. Approximate
5. Identification mark 6. An estimate of the residual hearing if
any and the basis on which this estimate has been arrived at .
i)
Right ear ii)
Left ear. 7. Onset
of deafness ( please state
whether deafness is from birth or acquired
later if it has been caused afterwards the age and cause of deafness may be indicated ) ( For the purpose of these scholarship the deaf are
those in whom the sense of hearing in
non-functional for the ordinary purpose of
life . Generally loss of hearing at 70 decibels or above at 500, 1000, 2000, frequencies
will make residual hearing non-functional ).
8. please state clearly whether the
candidate is deaf for the purpose of
scholarship.
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