FORM Q
See rule 29J(2) (a)

Notice of medical re-examination by Appellate Medical Board
No. Date
MEMORANDUM
Shri/Shrimati* ................................., Nature of employment......................Serial number from Form B Register...........................son/daughter/wife* of.......................,who has appealed for a re-examination against the findings of a medical examination under rule 29-B of Mines Rules, 1955, that he/she is unfit for:
(a) *Any employment in mines.
(b) *Any employment below ..........................., ground.
(c) *Any employment on work ................................. (specify in detail) is hereby notified that he/she* should present himself/herself* for a medical re-examination by the Appellate Medical Board at ................................(give exact description of place) on**................................ (give date) at ............................ (give time).
Shri/Shrimati *................................. may note that if he/she* fails, without reasonable cause, to submit himself/herself* for the medical re-examinaition aforesaid, he/she* shall not be retained in employment in the mine.
Signature of Manager
..........................Mine.