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Form No 10-Ia

This certificate certifies an individual as having a disability, severe disability, autism, cerebral palsy, or multiple disabilities for tax purposes. It contains the individual's name, age, gender, address, registration number, and diagnosis. It also specifies whether the condition is progressive, non-progressive, likely to improve, or not likely to improve. The certifying medical authority provides their name, institution address, qualifications, and signature.

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1K views1 page

Form No 10-Ia

This certificate certifies an individual as having a disability, severe disability, autism, cerebral palsy, or multiple disabilities for tax purposes. It contains the individual's name, age, gender, address, registration number, and diagnosis. It also specifies whether the condition is progressive, non-progressive, likely to improve, or not likely to improve. The certifying medical authority provides their name, institution address, qualifications, and signature.

Uploaded by

cooldude32166
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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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.

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