Request Letter for Issuance of Medical Certificate

__________ (Doctor’s Name),
__________ (Address)

Date: __/__/____ (Date)

Subject: Issuance of medical certificate

Respected Sir/ Madam,

I beg to state that my name is _________ (Name) and I am a resident of ________ (Location).

Respected, I would like to inform you that as per your prescription, issued on __/__/____ (date) I was advised to have rest for _____ (number of days) days from __/__/____ (date) to __/__/____ (date) and due to which I have to apply for leave from my _________ (school/ college/ office). To avail my sick leave I have to submit a medical certificate issued by you in my name.

I request you to kindly issue a medical certificate in my name so that I could avail medical leave. I shall be highly obliged for your kind support. For your kind reference, I am enclosing a copy of the prescription along with this letter.

Thanking You,
Yours Truly,
__________ (Signature)
__________ (Name),
__________ (Contact Number)

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