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

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

Page 1: 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