RANDHAWA HOSPITAL 42, Mall Road, Amritsar. Ph.: 0183-2226660, 98140-52303 Ref No:-RH/INT/ADM/TPA/ 44 Date:-11/8/17 To Sunrise Medicorp Solution 22A/11 Flat No 38 T-B Sapru Road Brindavan Colony civil Lines Allzhabad UP Subject: - Request for continuation Medicorp TPA. Sir, Greetings from Randhawa Hospital, 12 Mall Road, Amritsar. Refer to your mail dated 09 Aug 2017 for empanelment of Randhawa hospital with sunrise ‘medcorp solution please find enclosed document for further process of empanelment. Regards a GaBan} Administrative Incharge Randhawa Hospitel Mob-8779620264 Comprehensive Cardiac Care E-mail : drrandhawa@gmail.com hameeshranchawa@omail.com Website ; www.randhawahospital.comee a Sear ereud: Documents for empanelmemt tps: gooste-com*nall/\/0/"ul~28h=6620361 be24 jsver=Ajsy Gmail gaganjot singh Fwd: Documents for empanelment Dr'SJS Randhawa Wed, Aug 9, 2017-2 5:03 PM To: gaganjot singh —- Forwarded message From: network Date: Wed, Aug $, 2017 at 3:44 PM Subject: Documents for mpanoiment To: di.,randhawa@amail com Respected Sir/Madam, Greetings from Sunrise Medicorp Solution !! We wish to inform you that Sunrise Medicorp Solution Pvt. Ltd. in process of pan India hospitals Empanelment of our network list; we are pleased to invite you w be a part of our best healthcare network for offering quality healtheare treatment to our 7.6 Lakh Connection In Pan India Our Partner can choose to offer any or all of the below services to our clients, Offering Service4: Documents for emparielment ‘ntps:dival.google com/mail//(*ui-28ik=6620361 be2& js ver Alsy 1. Offer Cashless Hospitalization & Medical Tourism. 2. Discourited OPD and IPD Care using our Medisate Card, 3, Advanced Online Software : Real-time Cashless Hospitalization approval end Payment to the network service provider: 4. Online OPD Booking, 5, Create Profile of your hospital in Our network Portal along with your Hospital Map, Sunrise Medicorp opportunity: To partner to promote their organisation during Corporate Health eyents and can also participate in Corporate Health talks and other events. Distribution of Partners Promotional Vouchers to customers through Card Monthly statement and News letters. Our Software Benefits Mobile Responsive Support Cashless Hospitalisation instant Approval Process. Real-time Payment to Hospitals against the Cashtess Hospitalisation at the time o} ge. Value Added Services, Commerci: * Charges of IPD and OPD services empanelment are Rs 7980. 20F4. 1OAuewierd ja: Documents for empenelment btps/imail goog}e cornet /0/2ui=2Rik O62 OL DERE RSS Documents Required 1 Profieot Hospital / Diagnostic Centre. ‘Two Copies of MoU (Attached) duly signed and sealed:on all the pages eo 3, Panel of Doctors list with phone number & email Address 4 Daly filled, signed & sealed hospital information Sheet (attached) 5, Update detailed tariff list of the hospital 6 Xerox copy of PAN Card 7. Copy of agreement signed with other TPA / corporate (only the first & Last page) 34 Acancelled cheque Hospital broachers, Pamphlets ete 19 Hospital / Diagnostic centre, registration certificate Hi. Certification (if any) from accrediting ageney like 180 / NABH /JC1/JACO 12, Attach a Cheque OR DD RS 7980 /- in favour of "SUNRISE ME DYORY |a Aa: Documents for empanelment hitps:/imail. google corn/matl/w0/ui=28ik 662436 bed & jover=Ajsy SOLUTION PVT. LTD," Payable at ALLAHABAD Ignore this mail if you h Thanks & Regards Sunrise Medicorp Solutions (P) Ltd. 22A/11 Flat No.3 8 T-B Sapru Road Brindavan Colony Civil Line, Allahabad, Uttar Pradesh (211001) Website:-https://www,.srmecs.org, Email: network@srmes.in Contact us: Dr $$ Randhawa MD;DNB. Randhawa Hospital, 12 The Mall, Amritsar india. Treatment of heart disease without Bypass surgery or Stents. www .randhawahospital.com Phones: + +94 183 2226660 My Office + +91 183 2564039 Hosp Reception + #91 981 4052303 Mobile . 2 attachments | information xis =) SRMCS MOU.pof a 400K of4 OrAuweI7. 1262__[Hospitsl_Name Rannnawa Hos pdaf 3 [Adaresst 12,-Ma : a [Address Rise Office o_o. Plena fearm 7 [Bat NAB P see Jysyool 9 [Std Code DIES. an [et 222 6660. a [fax EMail for DR Far Osnail Gn | fE_Mail for EFT [EFerson w —— Gpgann et Sivan _ Desg iTpa_C_ Person BONN Anwt Trtnncte | GAG AIT SIAN 4 [ipa_C_Person_ Mobile oH F116 ~226Y, VO VEZ SEES cs [Reg No 3 [Pay_In Favor. OF iene 20 [Pan No “ABS EA rT SP1TAL____{ 2 [keeation lan 3 [Bank Name Pek et Tek a [Branch Zur = zs [Account No Rasch rr Te [IPSC_Code Pst 5 — = [Frovider Type eee 2 [Discount By. ay [Credit Period oe ee 0 Total Bed So a a flea Bed Nic 10 rs 4 a [Ne OFOE aL Carrently Empanelied with - apse THA AT, Paro) BUNS, BISA, frtien TO, 35_|which TPAS [Insurer troae provide names MDEC Cg? Beye} Aslicny Che ta [Have you ever depaniled by any ITPA / Insurance co (if Yes, Provide] |details/Reason) Gor el TH, Uoryend Fo ted banty Carers Alo ZSet BINS MEnICOBE "»HEALTH SERVICES AGREEME rT ‘This Health Services’ Agreement (‘Agreement’) is executed on (nis the day of 201_, at Allahabad, BETWEEN 4, Sunii¢e Medicorp'Solution Pvt. Ltd., a company incormorated under the provisiene of the Companies Act, 1956 with its Registered office . Sunrise MedicorP Solutions (P) Tid. 22A/11 Flat No.3 8 T.B Sapru Road Brindavan Colony Civil Lino, ‘Allahabad Utlar Pradesh 211001 Corporate office, Relerted to as "SRMCS", which ler shall inless ropugnant or contrary to the meaning and context thereot include its Successors-in-interest and permitted assigns) of the One Part AND. 2. Reascahiatie Hocprtef. (Name of the Health Facilitator) having Its dperations office at: JL, Hatt Roaat sectbee _herei nafier referred to as “HF” (which expression shall uniess if be repugnant to the context or meaning thereof shall deem fo-mean and include its successors or assignees) of the Other Part. SRMCS and the HF are heroinatter referred to,as a "Party" in the singular and as the “Parties” in the collective as the context may Require WHEREAS: A. SUNRISE MEDICORP SOLUTION PVT. LTD. is connected to the Heat Risk Management Sector and intending to render end-to-end services related to health for its Managerfas approached the HF for considering various facities inctuding.eredi 'e XP facility with the HF for providing services ‘of which it is capable of, at reasonable costs as agreed. SSRMCS wishes to avail medical facility for its members. seine ic engaged in the business of providing health care services as species Annexure | (hereinafter referred to as the "Services") and has represented to SRMCS that it has the requisite experience in providing the Services “The HF has offered to provide the Services and SRMCS has indicated its willingness to accept such offer of the HF; ae Be‘The HF has agreed to provide the Services to SRMCS in accordance with the terms and subject to the conditions set out hereunder. NOW, THEREFORE, in consideration of the promises and mutual covenants set forth in this Agreement, the Parties hereby agree to the terms and conditions set forth herein below: 4. SCOPE OF THIS AGREEMENT HF will be responsible for providing its services such as, conducting OPD Services, !PD Services, Preventive Health Screening Packages, Pharmacy, Dispensing ete. SUNRISE MEDICROP SOLUTIONPVT, LTD. who approaches the HF and at highly subsidized rates for customized corporate requirements routed through SUNRISE MEDICORP SOLUTION PT. LTD. In case of walk-in SRMCS customers with SRMCS unique ID cards, HF will take care of the same as per agreed terms In case of quarries generated by SRMCS card holders / customer care for consultation / treatment with prior appointment, HF will\respond through mail for the confirmation / rejection of the same (in case of rejection the hospital wil be responsible, SRMCS will be not responsible). The whole process will be web generated that will facilitate and smoothened the whole process from appointment to treatment 2. TERM A, This Agreement shall be in effect for an initial term of 01 (One) year commencing from __ day of 201_. The Initial Term would automatically get extended ona year to year basis unless terminated by a Party ("Renewal Terms"), by providing the other Party a written notice of its intention to terminate 30 days. The day before the expiry of the Initial Term or applicable Renewal Term. The Initia Term and any applicable Renewal Terms are collectively referred to hereinafter as The “Term". p Sol3, SERVICES. “The Services are mote particularly set out in Annexure | sali Services to be performed by the HF uncer this Agreement shall be performed by the employees of the HF alone except that the HF may engage professional doctors to provide services under this Agreement. 4A, RELATIONSHIP BETWEEN PARTIES ‘The HF shall perform its obligations under this Agreement as an independent contractor ona non-exclusive basis, and unless stated explicitly, nothing contained herein shall be deemed to create any partnership, joint venture, or relationship of principal and agent between SRMCS and the HF or any of their affliates or subsiciaries, or to provide either SRMCS or the HF with any tight, power or authority, whether express or implied, to create any such duty or obligation on behalf of the other. 5. CO-OPERATION BY THE PARTIES A. Each Party agrees to promptly provide the other Party with all such information, documentation and co-operetion which the other Party reasonably requests, i! such information, documentation and co-operation is required by the Party to comply with its obligations under this Agreement, provided that it (i) is nat Confidential information (as hereinafter defined); ane (i) is Capable of being provided by the Party from whom it is sought 6. CONFIDENTIALITY A. The HE shall keep confidential and not disclose or othenvise make available to any third perty, any confidential information, advice or material of any nature that is provided or made available by SRMCS;, including but not limited to SRMCS' employee's personal etails, information and health which includes any information related to any employees! health priot to, during and after any health check-up andior treatment, , any weitten reports or other data, and any Written or unwritten methodology, without the prior written consent of SRMCS. This section shall not apply to any informatian that. isin or comes into the public domain, other than as a result of breach by the recipient of the information of its obligations under this Agreement, tne recipient acquires from @ third party who owes no obligation of confidence-to the other party to this Agreement in3. SERVICES “The Services are more perticularly set out in Annexure | +All Services to be performed by the HF under this Agreement shail be performed by the employees of the HF alone except that the HF may engage professional doctors to provide services under this Agreement. 4, RELATIONSHIP BETWEEN PARTIES ‘The HF shall pertorm its obligations under this Agreement as an independent contractor ‘ona non-exclusive basis, and unless stated explicitly, netting contained herein shall be deemed to create any partnership, joint venture, or relationship of principal and agent between SRMCS and the HF or any of their affilates or subsidiaries, or to provide either SRMCS or the HF with any tight, power or authority, whether express or implied, to create any such duty or obligation on behalf of the other 5. CO-OPERATION BY THE PARTIES A. Each Party agrees to promptly provide the other Party with all such information, documentation and co-operetion which the other Party reasonably requests, if such information, documentation and co-operation is required by the Party to-comply with its obligations under this Agreement, provided that it (i) is not Confidential information (as hereinafter defined); ane (i) is Capable of being provided by the Party from whom it is sought 6. CONFIDENTIALITY A, The HF shall keep confidential and not disolose oF otherwise make available to any third perty, any confidential information, advice or material of any nature that is provided or made available by SRMCS, including but not limited to SRMCS" employee's personal details, information and health which includes any information related to any employees health prior to, during and after any health check-up andior treatment, , any written, reports or other data, and any Written or unwritten methodology, without the prior written consent of SRMCS. This section shall not apply to any information that is in or comes into the public domain, other than as a result of breach by the recipient of the information of its obligations under this Agreement, tne recipient acquires from @ third party who owes no obligation of confidence to the other party to this Agreement inrespect thereof, or was already known to the recipient at the time it received such information from the other party to this Agreement as shown by the recipient's prior written record. ifeither the HF or SRMCS is requested or required by any legel or investigative process to disclose eny information that it is not permitted to disclose, that party shall provide the other with prompt notice of each such request and the information requested so that the other party may seek to prevent disclosure or the entry of protective order. If disclosure is required and a protective order is not obtained, the party from whom disclosure is required shall disclose only such information that is advised by its counsel as is /egally required to be disclosed. 8. TERMINATION Either Party may terminate this Agreement by providing @ 30 days prior written notice of termination to the other Party; provided that the HF shall continue to perform its obligations under this Agreement during the notice period. Notwithstanding the above, in the event that the Partiés aré in breach of any of its obligations under this Agreement, partios shall have the right to terminate this Agreement forthwith or with a lesser prior written notice. 9. INDEMNITY The HF assumes the risk of and shail at all times defend, indemnify, protect anc keep harmless, SRMCS and its Representatives, associates, successors, and assigns against all claims and actions; losses, costs, fines, penalties and damages arising out of the breach by the HF or anyone acting under its direction or control er on its behalf, of any statutory or other obligations of the HF, including, but not limited to, those set out in this Agreement, and all expenses (including legal and investigation fees) incidental or consequent thereto subject to passing of award against the HF by a competant Court of Law, 10. NOTICES A. Any notice required or permitted to be given hereunder shall be in writing and sent by repaid registered mail or by a courier service, in the manner as elected by the Pariy giving such notice to the following addresses: If 10 SRMCS:, . Sunrise Medicorp Solutions (P) Lid, 224/11 Flat No.3 8 T.B Sapru Rosd Brindavan Colony Civil Line, Allahabad, Uttar Pradesh 211001 ,. if to the HF: B. All notices shall be deemed to have been validly given on the business date of receiptof the courier of registered mailen lie Either Party may. trom time to lime, enande its address or Representative fot receipt of Fotiges provided for in this Agreement BY giving to the other Party not fess than thirty (30) days prior writen notice in ecordance with this Clause 14 44, FORCE MAJEURE ‘A, Neither party wil incur any lability to the other party on account of any [OSs Of damage resulting from any delay or failure to perform all or any part of this Agreement if such delay oF failure is caused, 19 whole or in part, by events, occurrences of forces beyond the reasonable Contre}, snithout the negligence of such Party and the affected Party has acted diligently (nereinafter Teforred 0 as a "Force Majeure Event). If Party ie affected by the: Force Majeure Event, the Party so affected will promptly nati the other Party in writing of the occurrence of the Force Majeure Event (and the likely duration of the impact or delay caused by the Force: Majeure Event) and the performance of its obligations wit be suspended during the period thal ihe Fore Majeure Events persist and the affected Party will be granted an extensio? of time for performance equel to the period of ‘Telay attabutable to the Force Majeure Event 42, ASSIGNMENT ‘A The HE may assign this Agreement of any of the tights hereunder or delegate any of iis obligations hereunder, only after obtaining the prior written consent of SRMCS. B.SRMCS may assign this Agreamont or any ofthe righis hereunder or delegate any rit obligations hereunder to aniAftiiate oF any third party by way of a writen intimation to the HF of such assignment. Refer Patient. In Case patient is in the serious condition then the patient will be send to the SRMCS network Hospital 43. GOVERNING LAW AND DISPUTE RESOLUTION A. AI disputes arising out of this agreement shall be referred to 9 sole arbitrator appointad by Diregior of Sunrise ‘Madicorp Solution Pvt. Lid, in accordance with the provisions of tie Arbitration and Gonecliaion Ack 1996 or any statutory amendments or modifications thereof ("Arbitration Act) With respect to such artitration, the following provisions shall apply: {) The arbitration proceedings shell be conducted in English(i) The place of arbitration shall be Allahabad {i In respact of matters where a reference to the cour's 6 permitted by the Arbitration ‘Act, the courts at Allahabad | shall have exclusive jurisdiction: and {iv) The docision of the arbitrator(s) shall be final and binding on the Parties 14. MISCELLANEOUS ‘A. Each Party shall pay the costs and: expenses incurred by It In connection with the ‘execution of and completion of this Agreement. B. THis Agreement may be executed by the Parties in one or mo/e counterparis, and ach of which when 80 executed shall be an orginal But all such counterparts shall constitute one and the same instrument. C. The Parties agree that any amendment to be made to this Agreement shall be upon the mutual, written understanding of both Parties. The Parties furlnor agi that such ‘amendment shall come into effect within fseven (7)] days from the date of such mutual agreement in writing or on such other date as agreed upon by the Parties in writing. D The Parties agree that iF any of the provisions of this Agreement are declared invalid, ilagal or unenforceable at any time during the Term. the remaining provisions of this Agreement shall continue to be in force and tnis Agreement shall be interpreted accordingly. E. Tho Parlies represent that they are authorized to execute th's ‘Agreement and that they have obtained all applicable approvals and permissions to execute this Agreement F. This Agreement, the Annexure hereto, and other documents inebiporated herein by reference, Is the final, full ancl exclusive ‘expression of the agreement of the Parties and supersedes ll prior agreements, understandings. smitings, proposels, representations and cornmunications, oral of written, of either Party with respect to the subject matter hereof and the trensactions contemplated hereby IN WITNESS WHEREAS, the: Parties hereto have caused his ‘Agreement to be executed as of the date written below by their duly authorized reprosentatives For: Sunrise Medicorp Solution Private Limited For: For Hospital Neme: Designation: Director ‘Dr, SIS Aanclhaust WITNESS Homa Oreste 1) Gaaawror Swan € Gd.)ANNEXURE | PE OF SERVICES AND CHARGES scot (Non heath card holder) go Cover) 5 Discounts to.cash patient Over and Above Insurans The SRMC a. IPD (Cash Patient 0! p.opp-_S% , LAB/ Diagn: sti imaging -_ 5" ‘on 6d dé. Pharmacy ~ O% cetoatth Checkups -_—¥— AS yl 7 sit wll apptieable on SRMICS agreed cate with HE. Note: All the diseout snment Organization 2. CGHS Rates for PSU / Gove (agrees / Diss a, The HF hereby grees) 0 reat (OPD / Diagnose Investigation | pb) all employees of PSU and Government Organization (tnreugt SRMCS) at CGHS rates only: ent ithe HF hereby aareesto grant? wagh SRMCS. gat TOS discount of 10% for el cases of PSUIGOVEIN™ employees thro 9. Credit Limit imit of RS. Apa te athe HF hereby agrees to provide & emonthiy crest li less cases duly approved BY SRMCS claim dept for all Cashl 5, Registration Charges «to pay one time regsiration fee af ee 7980 |- 2s si time remsiraton fore forthe spanetiod wiih SRMCS for athe heath Purpose of online software 2nd training & getting e' Related services.NY Name of the employee Working Fi ~~ father's name From Young Peiwons Maks: 1 : 2 3 | a | 4 + 2 a 4 © opaahi. Sham ofp Yor pol 6 7 e F Ganh Bur We Bath Sy” 0 {FORM-3 | Senos ean onan! NOTICE TO BE EXHIETED UNDER SCCTION 20 (1) OF THE SHOPS AND COMMERCIAL ESTABLISHMENTS ACT 1992 {ute of ihe Punjeb Shope and Commercial Est ‘ 1 Closed day, if any... eae yee. 22 2. Opening hour of the Estabtistiment. Seam Closing hour of the Ramhyshment x facie 3. Nampe® Pxertage of thesmpiayer. ae aa 8 Werte ot 6 EWlablishment....... Kae bmpid....../Hurm nin naRrte : lay OM Reonbhy. © Name ot Busine: 7_Full addeans... Over Perron Sst, Kanng, g Reeit ROMER BASEL Cee oh, Maatey Sgt Headey Pee ap Sagal Gah Staged ay ae Guebid Soph DR SS Gh Eg Fak ait ay ve tt begs yy oogh Seyy. ch Uethoomby Sas | OY ronbida. to, Op thrbed Sh Wiesiek cay dle Aron Day Henjmet Man le Dei Gye Keres Wo oh eval Sah os Nery piv, Son Sh, wey Kaw Ob A | foot SE tin rj Oey |S Be wit Detelatation.... bY authoritiesRTGS /NEFT Mandate Form spital Ta | Name ofthe Bank where fund transfor is requested “Bani Account Namter | ani rach 16") type of Bank A7E Permanent Accnant Number T Attach copy of one Cam | 15 [Wowie wa ie gated Email 1 for adviee communication transier RANDHAWA HOSPITAL 12 Mall road, Amiritoar Punjab & Sindh banke O5A91100030896 Court Road ‘Braritene xcnaieaeaeaail com Randhawa hospital Aia aaneemennnenemn anaes cesT CEA ERJIT SINGH RANOHAWA g ne ONTcareee RCS, Pe ATE prot RT cdovessneer.sr Imps, Minin #¥ 08 FEN econ: TAX DEPARTS oe rea, ae et, HSS ST ‘Cuist COMMIDSTIONER OF INGie He OF INGORE Taye EFOR OFT paraae ns ‘Mageoat OP iss 19300 e wooie 8862 approval of nospital Sader eagsianse’ @) of clrase f9 of proviso to section 1712) oy the Tmeome ‘Tax Act; 1954 the esse of M/s. Randkown Hospitals Px? De. Si Randhawa, 12, Ball 89 penritsa @o)- 1 fa clei ar tne pews contertne ye Chief Commissioner of eo vo soeion 1 THz tocorpe Tas under sub ciatse G10) of pre pak Act, 1964, 1 the Cet Se rey aden af iigeee Tse AIT SE a reeves vo cee puraetines osesenDE Mable Att) af the Uncen: Ts BY for grant of approvel tM Ranuthawa Hospital Prop. OF ae! 2 we pond, Ameitgas (bs) for the ESTES of the af provise te section 172) fens treome Tax Aes UF 2 nagar eld ty mE CERO SF spect 2 ant > soatly neared by the emPOYS Se te medical treatment © sespita in cespect of tbe EEE pember of his family 37 the so ct ote cts Tos il casi not be treated 38 0 F Fe pats of ne ermpaoye for the PAPAS enon 16. tg.and 17 ote Ene aa Bet, 1861. 3 Accotdinayy ary om paid DY BT aaghiner to. Mie. Randhase Hospnal Trap, De Sa. SANS DD, Mall Read. 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