APPLICATION FOR MEDICAL CREDIT CARD FOR TSTRANSCO

I Employee /Pensioner Details

1 Personnel No(Employee/Pensioner ID)
2 Name
3 Designation
4 Place of working
5 Employee/attendant Email
6 Employee/attendant Contact No.

II Patient Details
1 Patient Name
2 Relationship
3 Date of Birth (dd.mm.yyyy)
4 Age

III HOSPITAL DETAILS

1 Hospital ID
2 Hospital Email Id

3 Hospital Contact No.(Mobile No.)

(Credit Card SMS will be sent to this No.)
4 In patient No.
5 Estimation date (dd.mm.yyyy)
6 Admission Date (dd.mm.yyyy)
7 Name of Recommended Doctor
8 Disease Name
9 Hospital Estimation in Rs.

All the fields are mandatory

Note: It is requested to attach the Hospital estimation along with filled in application and Employee/Pensioner ID Card to the
(1) Concerned Controlling Officer EMail ID in the drop down list
(2) cgm.hrd@tstransco.in
(3) medical.hq@tstransco.in
(4)pomedicaltstransco@gmail.com
(5) hr.module@tstransco.in
APPLICATION FOR MEDICAL CREDIT CARD FOR TSTRANSCO
Employee /Pensioner Details

Patient Details

HOSPITAL DETAILS

All the fields are mandatory

 on along with filled in application and Employee/Pensioner ID Card to the
ail ID in the drop down list