Scribd Logo
Importer

Bienvenue sur Scribd !

  • Medical Card

    Transféré par

    Deepak Sharma
    213 vues2 pages
    It requests personal information about the applicant such as name, designation, place of work, date of birth, date of appointment, basic pay, pension details if retired, and residential address. It also asks for details of family members and the nearest Delhi government dispensary. The applicant confirms their monthly subscription amount deducted from pay is being deducted regularly.

    Description originale:

    medical card application form

    Titre original

    medical card

    Copyright

    © © All Rights Reserved

    Formats disponibles

    PDF, TXT ou lisez en ligne sur Scribd

    Avez-vous trouvé ce document utile ?

    Ce contenu est-il inapproprié ?

    Signaler ce document
    It requests personal information about the applicant such as name, designation, place of work, date of birth, date of appointment, basic pay, pension details if retired, and residential address. It also asks for details of family members and the nearest Delhi government dispensary. The applicant confirms their monthly subscription amount deducted from pay is being deducted regularly.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    213 vues2 pages

    Medical Card

    Transféré par

    Deepak Sharma
    It requests personal information about the applicant such as name, designation, place of work, date of birth, date of appointment, basic pay, pension details if retired, and residential address. It also asks for details of family members and the nearest Delhi government dispensary. The applicant confirms their monthly subscription amount deducted from pay is being deducted regularly.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 2

    PHOTOGRAPH

    PESTING
    (In Duplicate)
    GOVERNMENT OF NCT OF DELHI
    OFFICE OF THE DEPUTY DIRECTOR OF EDUCATION (SOUTH EAST)
    DISTRICT: SOUTH EAST ZONE: 25

    APPLICATON FOR ISSUE OF MEDICAL FACILITY CARD

    Name of the Beneficiary & ID :- .........................................................................................................

    Designation & Dept. :- …………………………………………………………………………

    Place of Posting & working :- ………………………………………………………………………….

    Date of Birth :- ..........................................................................

    Date of Appointment :- ..........................................................................

    Date of Retirement: - ..........................................................................

    Basic Pay Last Drawn : - ..........................................................................

    Basic Pension (In Case of Retirement) :- ..........................................................................

    Revised Basic Pension: - ..............................................................................................

    Residential Address: - ..........................................................................................................

    ……………………………………………………………………………………………………….

    Nearest Delhi Government Dispensary :- ………………………………………………………….

    Details of Family as per the Service Record :-

    S.N. Name of Beneficiary & Family Members Date of Birth Relationship with the
    Beneficiary

    13. Amount of Subscription based on Gr. Pay being deducted from pay per month regularly @ Rs. ……………….
    Per month in case of service employees.

    14. Lumsum amount deposited vide TR-V No. Dt. ......……… Rs…………….. and bank Challan
    no.……………… dated …………….. in case of retired employees.

    Signature of the Beneficiary


    PHONE No.-
    Counter signed of Principal/HOS
    PHOTOGRAPH
    PESTING
    (In Duplicate)

    Vous aimerez peut-être aussi