Panchayat:Repo18/Law Manual Page0610
1.Name and address of applicant:
2. Name and address of the existing private hospital / private para medical institution:
3. Date of starting of the institution:
4. Nature of functioning of the institution:
5. If a hospital, number of beds
6. (1) Number of doctors
- (2) Number of other employees working in the institution
(category wise)
7. If a training centre, subjects in which training is given, facilities for training and number of trainees
8.Particulars regarding remittance of registration fee
Place:
Date :
1.Date of receipt of application:
2.Whether registration fees has been remitted or not:
3.Enquiry report:
4.Number and date of registration
1.Name and address of applicant:
2. Name and address of the private hospital / private para medical institution:
3. Registration number and date:
4. If a hospital, number of beds
5. (1) Number of doctors
- (2) Number of other employees working in the institution
(category wise)
6. In the case of training centres if any, new training subject has been :
7.Particulars regarding the remittance of registration fees for renewal of registration
Place:
Date :
1.Date of receipt of application:
2.Whether registration fees has been remitted or not:
3.Particulars regarding annual fees levied
4. Whether registration is renewed or not (if not, state the reason briefly):
5. If the registration has been renewed the renewed registration number and date: