Physical Fitness Certificate Template Page 2
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1
2CERTIFICATE OF PHYSICAL FITNESS
NAME OF THE CANDIDATE:
Pulse
/Min
Height
Cms
BP
Mm/ Hg
Weight
Kgs
Bodily Infirmity
BMI
Communicable Disease
Build
Pallor
Icterus
Clubbing
Cyanosis
Lymphadenopathy
Oedema
Tonsils
Glands
Teeth
C V S
Heart Sounds
Murmurs
R S
Breath Sounds
Added Sounds
G I S
Liver
Spleen
Any
Mass
C N S
Cranial Nerves
Motor System
Sensory
System
G.U.S (Male)
Hydrocele
Piles
Phymosis
G.U.S.(Female)
Menstrual History
Skin
Hearing
Vision (NV/DV)
Colour Vision
Normal / Corrected (Power)
Other Findings / remarks
if any.
________________________
______________________
(Signature of the candidate)
(Signature of the Parent)
I do hereby certify that I / We have examined Mr. / Ms. _____________________________________________, a
candidate for student under VIT University, _____________ Campus and whose signature is given above, and cannot
discover that he / she has any disease, communicable, otherwise or constitutional affection or bodily infirmity except
that his / her weight is in excess of / below the standard prescribed or except ____________________________
I also certify that he / she has been vaccinated and had booster against Hepatitis A, B, TT, Typhoid, Chicken pox &
Measles
Name of the Doctor
:
Photograph of
the candidate to
Signature of the Doctor :
be affixed and
Designation
:
attested by the
Date & Place
:
Doctor
Seal with Reg.No.
:
Page 2
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