Omitted - Certificate of prescribed authority for the purposes of section 80DDB

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..... 2. Address 3. Father s Name 4. Name and address of the person on whom the patient is dependent and his relationship with the patient 5. Name of the disease or ailment (please see rule 11DD) 6. For diseases or ailments mentioned in item (i) of clause(a) of sub-rule(1), whether the disability is 40% or more (Please specify the extent) .....

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..... Date Signature Place .. (Name and address) To be countersigned by the Head of Government hospital, where the prescribed authority is a specialist with post-graduate degree in General or Internal Medicine. Date .....

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