PMNRF Assistance Form PDF

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PMNRF Assistance Form PDF Free Download

PMNRF Assistance Form

  1. Name of the Patient
  2. Age/Sex of the Patient
  3. Father’s /Husband’s name
  4. Number of Family members
  5. Residential address for correspondence. Please enclose a copy of the proof.
  6. Contact details of the patient/applicant
    Telephone/Mobile No.
    E-mail ID
  7. AADHAAR-Card No.
    (Please enclose a self-attested copy of the
    card.)
  8. Nature of Disease/ailment/Treatment Required
  9. A Quantum of Financial Assistance is required for future treatment as per the estimate given by the hospital.
    Please enclose the Expenditure Estimate from the Govt./private impaneled hospital.
    The list of the private impaneled hospital may be accessed at https://pmnrf.gov.in
  10. Whether any assistance from PMNRF was received on earlier occasions by the patient.
    If so, mention file No. of the Sanction/Release letter.
Language English
No. of Pages2
PDF Size0.06 MB
CategoryGovernment
Source/Credits

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PMNRF Assistance Form PDF Free Download

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