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Authorized Representative Details
Name of the Authorized representative
*
Needed Authorized representative.
Designation
*
Needed Designation.
Organization
*
Needed Organization.
Email Id
*
Needed Email Id.
Contact No
*
Needed Contact No.
Applicant/PoC Details
Name of the Applicant/PoC
*
Needed Authorized representative.
Designation
*
Needed Designation.
Organization
*
Needed Organization.
Email Id
*
Needed Email Id.
City
*
Needed City
Contact No
*
Needed Contact No.
GST No
*
Needed GST No.
Pincode
*
Needed Pincode
Address
*
Needed Address.
Category
*
Private Sector
Public Sector / NGO / Trust / Start-Ups
Needed Category.
Category Applied For
Select Category
Upload at least one category
Excellence in Service
Excellence in Patient Safety
Excellence in Home Healthcare
Excellence in Capacity Building
Excellence in Social Initiative
Digital Innovation in Healthcare
Select file please!
Registration Certificate/proof of Incorporation certificate of the participating entity (pdf file)
*
Project initiation date on organization's letter head (pdf file)
*
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