Application For Classi Medical Www.victortango.in

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APPOINTMENT FOR RENEWAL / INITIAL MEDICAL EXAMINATION To, AFCME, Subroto Park, New Delhi-110010 IAM IAF Vimanpura Bangalore 560017 Medical Evaluation Cell (East) 5 Air Force Hospital Rowriah Dist. Jorhat (Assam) 788005

Date

Sir / Madam, Kindly oblige me by giving medical appointment at your establishment as per particulars mentioned below. License / File No.

Name Of Candidate

Date of Birth Date & Place of last Medical & Age

Requested Date

Address:

Contact No. :

Email:

Appointment accorded on:

General Instructions 1.

You are advised to:a. To report to this establishment on an empty stomach at 0730 hrs on the appointment date.

2 b. To bring two passport size photographs. c. To pay Rs /1990- for Initial and Rs 1000/- for Renewal, Rs 60/-(if ECG due) as examination fee at the Civil Aircrew Reception Counter on the appointment date. d. To ensure that the PMR reaches this establishment before the appointment date, by writing to DGCA at least 45 days in advance. The candidate is responsible for positioning the PMR at the medical boarding center. e. You can confirm the receipt of PMR at the medical center. The contact numbers for the DGCA & the Air Force Boarding Centers are given at the website http://dgca.nic.in/ f. Candidates above 35 yrs of age are required to bring the following reports, done within the last one month. (i) TMT (ii) Lipid Profile (iii) Bio Chemical Profile (Blood Sugar F/PP, Blood Urea/ Creatinine / Uric Acid, SGOT / SGPT, LFT, HBA1C & Serum PSA). (iv) USG Abdomen & Pelvis. g. Serving Officers are required to bring:(i) (ii)

NOC from Competent authority. AFMSF-I (Medical Document)

Kindly send a self addressed stamped envelope along with completed form.

Sign of OIC Med Board

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