FORM B
[See sub-rule (6) of Rule 4]

Certificate of approval.
The place described below is hereby approved for the purpose of the Medical Termination of Pregnancy Act, 1971 (34 of 1971).
            Name of the Place        Address and other        Name of the owner
                                                descriptions
            ______________        ______________        ______________
            Place:               to the Government of the _____________
            Date: