top of page
Basic Information
Bank Details
Basic Information
Hospital Rohini Id *
Please fill this mandatory field
GSTN Details *
Please fill this mandatory field
Year of Incorporation *
Please fill this mandatory field
Directors/Owners Name *
Please fill this mandatory field
Directors/Owners Number *
Please fill this mandatory field
Directors/Owners Aadhar Card No *
Please fill this mandatory field
Directors/Owners Pan Card No *
Please fill this mandatory field
Ownership
Hospital Name *
Please fill this mandatory field
Hospital Address *
Please fill this mandatory field
Accreditattion
POC
Admin Name
Admin Contact
Admin Email
Auth signatory Name
Auth signatory Contact
Auth signatory Email
bottom of page