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7. Whether Physically Handicapped

(i)

Vision

(ii)

Speech

(iii)

Hearing

(iv)

Limbs

:

Yes/No (If Yes specify the defect and the extent of disability)

Whether the candidate is physically eligible to be considered for admission in Anna University Chennai

Yes/No

(If No specify the reasons)

8

OPINION :

with the above clinical details please specify

Place :

Register No. :

Date :

Full Address:

Signature of the Candidate

Signature of Regd.Medical Practitioner

13

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