Form 10-IA:Certificate of the medical authority for certifying ‘person with disability’, ‘severe disability’, ‘autism’, ‘cerebral palsy’ and ‘multiple disability’ for purposes of sec 80DD and sec 80U

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FORM NO. 10-IA
[See sub-rule (2) of rule 11A]

Certificate of the medical authority for certifying ‘person with disability’, ‘severe
disability’, ‘autism’, ‘cerebral palsy’ and ‘multiple disability’ for purposes of section
80DD and section 80U

Certificate No.
Date :
This is to certify that Shri/Smt./Ms._______________________________ son/daughter of Shri_________________________________, age______ years___________male/female residing at____________________________________, Registration No.__________is a person with disability/severe disability suffering from autism/cerebral palsy/multiple disability.
2. This condition is progressive/non-progressive/likely to improve/not likely to improve.
3. Reassessment is recommended/not recommended after a period
of__________months/years.
Sd/-
(Neurologist/Pediatric Neurologist/Civil Surgeon/
Chief Medical Officer)
Name :___________________
Address of Institution/Government hospital :
____________________________________
____________________________________
Qualification/designation of specialist :____________________
SEAL
Signature/Thumb impression of the patient
Note : Strike out whichever is not applicable.