👤 Applicant Details
👁 Medical Examination
👨⚕️ Doctor Details
Government of India · Ministry of Road Transport & Highways
FORM 1A
[See Rule 5(1), 5(2), 5(3)(a) and 5(4)] · Medical Certificate
Medical Certificate for Driving License
Cert. No: F1A001 | Date: 25 Aug 2026
Photo
Applicant Name
________________
Age / Gender
__ / Male
Address
12, MG Road, Bangalore
Blood Group
O+ve
License Category
MCWG + LMV
Identification & Medical Examination
ID Marks: Mole on right cheek
Blood Pressure: 120/80 mmHg
Right Eye Vision: 6/6
Left Eye Vision: 6/6
Colour Blindness: Normal
Hearing: Normal
Disability / Disease: None
Declaration: I, the undersigned registered medical practitioner, hereby certify that I have personally examined the applicant and found that:
(a) The applicant is / is not suffering from any disease or disability likely to cause driving to be a source of danger to the public
(b) The applicant's vision and hearing are satisfactory for driving a motor vehicle of the specified description
(a) The applicant is / is not suffering from any disease or disability likely to cause driving to be a source of danger to the public
(b) The applicant's vision and hearing are satisfactory for driving a motor vehicle of the specified description
Medical Opinion
FIT TO DRIVE
For category: MCWG + LMV
Applicant Signature
FIT TO
DRIVE ✓
DRIVE ✓
Dr. R. Sharma
Dr. R. Sharma
MBBS, MD
Reg: MCI-12345/2020
MBBS, MD
Reg: MCI-12345/2020