Employee Code 1 NO OF CGHS IDENTITY CARD 2 NAME OF THE GOVT SERVANT 3 MINISTRYOFFICE IN WHICH WORKING ID: 311042
Download Pdf The PPT/PDF document "APPLICATION FORM FOR ADDITION / DELETION" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
APPLICATION FORM FOR ADDITION / DELETION Employee Code 1. NO. OF CGHS IDENTITY CARD 2. NAME OF THE GOVT. SERVANT 3. MINISTRY/OFFICE IN WHICH WORKING 4. NEW ADDITION/DELETION Sl.no. Name Date of Birth Relation 5. SIGNATURE OF GOVT. SERVANT / : ________________________________ THUMB IMPRESSION. Date : 6. SIGNATURE AND DESIGNATION OF : _______________________________ ISSUING AUTHORITY / SEAL 7. SIGNATURE OF MEDICAL OFFICER : _______________________________ Note : Form must be filled in triplicate along with the photographs and submit to Administration-I