FORM 1-A [See Rules 5(1), (3), (7), 10(a), 14(d) and 18(d)] MEDICAL CERTIFICATE Space for passport size photograph [To be filled in by a registered medical practitioner appointed for the purpose by the State Government or person authorised in this behalf by the State Government referred to under sub-section (3) of Section 8.] 1.

Preparation, Submission and Filing of the Offering Statement. An offering statement must be prepared by all persons seeking exemption under the provisions of Regulation A. Parts I, II and III must be addressed by all issuers.

Use this Form-1A for all employment status changes including retirement. If enrolling in GIC health insurance coverage for the first time at retirement, you must also complete and return Form-RS.

Title: FORM: 1A - Filing Status and Exemption Author: WCC Subject: Connecticut Workers' Compensation Commission Agency Forms Created Date: 7/9/2009 8:48:38 AM

Form 1A is a medical fitness certificate needed by the Regional Transport Office (RTO) in India. It’s important when renewing your driving license or applying for certain kinds of licenses. It checks how fit you are overall, including your eyesight and hearing. A registered medical practitioner must fill out & sign the form.

[Form I (A) should be filled by a registered medical practitioner who is at least MBBS and above, by the State Government referred to under sub-section (3) of section 8.] 1.