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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
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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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