Factories Act · Form 5
Form 5 — Certificate of Fitness
General fitness certificate issued by Certifying Surgeon — for young persons (Sec 69) and women/adolescents in restricted processes.
Rule: Rule 19(2) · Signed by: Authorized Certifying Surgeon · MFR 1963: Form 6
General fitness certificate issued by Certifying Surgeon — for young persons (Sec 69) and women/adolescents in restricted processes.
What the form records
- Serial Number + Date
- Name of person examined
- Father's name
- Sex
- Residence
- Date of birth / certified age
- Physical fitness (fit as adult / child)
- Descriptive marks
- Reason for refusal (if any)
- Signature/thumb of examined person
- Signature of Certifying Surgeon
Blank statutory template. Fill, save and print Form 5 in MedFactory, or view the official layout in the Model Factories Rules gazette.
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