Empanelment of Eyes Care Centres - ECHS
Empanelment of Eyes Care Centres - ECHS
Empanelment of Eyes Care Centres - ECHS
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Annexure<br />
CHECK LIST FOR DOCUMENTS FOR EMPANELMENT APPLICATIONS OF ______________________________________________________________________<br />
TELE NO _____________________ RC, _______________________<br />
Ser Name <strong>of</strong> Documents Applicable<br />
(Yes/No)<br />
1. CD CONTAINING SCANNED COPY OF<br />
APPLICATION.<br />
2. HARD COPY AND CD TO TALLY.<br />
3. PAGES OF APPLICATION/ ANNEXURES TO BE<br />
SERIALLY NUMBERED.<br />
4. AUTHENTICATION OF EVERY PAGE BY<br />
AUTHORISED PERSON<br />
5. PARTNERSHIP AGREEMENT AND DEED DULY<br />
AUTHENTICATED BY NOTARY.<br />
6. PHOTOCOPY OF MRO FOR APPLICATION FEE-<br />
RS. 1,000.00 DULY AUTHENTICATED BY<br />
DIRECTOR, REGIONAL CENTRE <strong>ECHS</strong><br />
7. PHOTOCOPY OF BANK GUARANTEE FOR<br />
EARNEST MONEY-RS 1,00,000.00 DULY<br />
AUTHENTICATED BY DIRECTOR, REGIONAL<br />
CENTRE <strong>ECHS</strong>.<br />
8. DD FOR INSPECTION FEE- DD IN FAVOUR OF<br />
QCI (FOR NON NABH)<br />
9. COPY OF CERTIFICATE OF STATE HEALTH<br />
AUTHORITY RECOGNISING THE HOSPITAL.<br />
10. COPY OF AUDITED BALANCE SHEET FOR LAST<br />
THREE YEARS.<br />
11. COPY OF LEGAL STATUS FOR CONDUCTING<br />
BUSINESS UNDER GOVT AGENCY<br />
(REGISTRATION & PLACE OF BUSINESS OF<br />
HOSPITAL).<br />
12. COPY OF CUSTOMS DUTY EXEMPTION<br />
CERTIFICATE GIVING CONDITIONS OF<br />
EXEMPTION.<br />
13. PHOTOCOPY OF PAN CARD.<br />
14. NAME AND ADDRESS OF BANKERS.<br />
15. COPY OF EXISTING LIST OF RATES APPROVED<br />
BY HOSPITAL.<br />
Attached<br />
(Yes/No)<br />
Date <strong>of</strong><br />
Validity <strong>of</strong><br />
Certificates<br />
If attached then<br />
page number<br />
From To<br />
Remarks
Change language