AUTO GENERATED

Registration No : 0001545763
RECEIPT FOR DOCUMENTS CUM TEMPORARY RECEIPT EX SERVICEMEN CONTRIBUTORY
HEALTH SCHEME (ECHS)
TEMPORARY SLIP TO BE ACTIVATED ONLY AFTER (30 Sep 2020)
Received documents from No 14843291WRank SepName K MEGANATHAN towards
1.
application for membership of Ex-Servicemen Contributory Health Scheme (ECHS) :-
Pension Payment Order No (PPO No)
2. 180202004771
(Attach photocopy)
3. Category of Ward General
4. Force Type: Army 5. Regiment/Unit: 5004 ASC BN
Permanent Address with State and Pin Current Address with State and Pin Code:
Code: VILL-SEMBARAYANALLORE PO-
6.
VILL-G R PALLYAM PO- G R PALLYAM, SEMBARAYANALLORE, KATPADI, Vellore, Tamil
VELLORE, Vellore, Tamil Nadu , 632105 Nadu , 632519
Mobile No: 8. DOB: 01 Jun
7. 9. Date of Retirement: 30 Sep 2020
9365384909 1984
10. Parent Polyclinic of Pensioner Vellore, MRO No. (if applicable)
11. Card Charges @ Rs. 177/- paid Rs. : 531 vide Transaction ID : CPAADLPMZ0
12. Valid Upto : _________________

Primary Beneficiary Spouse Daughter

Name : K MEGANATHAN Name : M SARUMATHI Name : M SARMITHA

DOB : 01 Jun 1984 DOB : 18 Jun 1987 DOB : 24 Nov 2012
Aadhaar No. : 599728530487 Aadhaar No. : 969400673934 Aadhaar No. : 302509741360
13. ACTIVATION BY
Signature _________________
Place: _____________
(Stamp with Rank, Name & Appointment, OIC
Date: _____________
Parent Polyclinic)
Notes :-
This original receipt is required to be returned at the time of collection of Smart Card
1. (s). Receipt will not be destroyed. This will be filed along with the original Application
Form.
2. No Smart Card will be issued if this receipt in original is not produced and final
 verification by Central Org ECHS.
Record Office will retain this receipt after checking the Application Form till retirement
3.
of the individual
Stoppage of FMA and deposition of contribution (MRO) as applicable to be ensured
4.
prior to issue of this receipt to pre 01 Apr 2003 retirees by Regional Centre ECHS.
This receipt will be issued only on verification of original PPO and discharge book for
5.
old retirees who are not in possession of old Cards.
6. The Original Receipt is valid up to a maximum of SIX MONTHS from the date of issue.
7. Slip will be considered activated only after signatures of OIC Parent Polyclinic.
8. Aadhar verification to be ensured by Polyclinics.
9. Old cards/ temp receipts will be returned.

Date: 25 Sep 2021

Signature of ESM / Family Pensioner