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Medical Certificate for the Deaf
Certified that I, Dr.
Registration
No
.. have
this
Day
of
200..
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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