Form to Correct Errors in CGHS Card
1
APPLICATION FOR CORRECTION OF ERROR IN PLASTIC CARD Name of Beneficiary Ben. 10 No. Name of Family Member 1. 2. 3. 4. 5. 6. 7. Dispensary Nature of Correction Change of Ward Correction Required From Ward to in rIo all the above 10 Nos. Contact Telephone No Ene!: Photo Copy of Pay Slip & CGHS 10 Cards Signature of Applicant
-
Upload
sachinkurhekar -
Category
Documents
-
view
1.104 -
download
1
description
Highly useful form for those who have received CGHS Cards with errors, so as to correct them.
Transcript of Form to Correct Errors in CGHS Card
APPLICATION FOR CORRECTION OF ERROR IN PLASTIC CARD
Name of Beneficiary
Ben. 10 No.
Name of Family Member 1.
2.
3.
4.
5.
6.
7.
Dispensary
Nature of Correction Change of Ward
Correction Required From Ward to in rIo all theabove 10 Nos.
Contact Telephone No
Ene!: Photo Copy ofPay Slip & CGHS10 Cards
Signature of Applicant