AUTO GENERATED

Registration No : 0002378053
RECEIPT FOR DOCUMENTS CUM TEMPORARY RECEIPT EX SERVICEMEN CONTRIBUTORY
HEALTH SCHEME (ECHS)
Received documents from No JC331750YRank Sub MajName BEERPAL towards
1.
application for membership of Ex-Servicemen Contributory Health Scheme (ECHS) :-
Pension Payment Order No (PPO No) (Attach
2. 212202201584
photocopy)
3. Category of Ward Semi-Private
4. Force Type: Army 5. Regiment/Unit: CWE, MEERUT
Current Address with State and Pin
Permanent Address with State and Pin Code:
Code:
C-131,SAINIK VIHAR, C-POCKET, KANKER
6. C-131,SAINIK VIHAR, C-POCKET,
KHERA, MEERUT , Meerut, Uttar Pradesh ,
KANKER KHERA, MEERUT , Meerut,
250001
Uttar Pradesh , 250001
7. Mobile No: 7066988212 8. DOB: 04 Jul 1970 9. Date of Retirement: 17 Aug 2022
10. Parent Polyclinic of Pensioner Meerut, MRO No. (if applicable)
11. Card Charges @ Rs. 177/- paid Rs. : 177 vide Transaction ID : 18205750769
12. Valid Upto : _________________

Spouse

Name : SUNITA
DOB : 15 Jan 1974
13. ACTIVATION BY
Signature _________________
Place: _____________
(Stamp with Rank, Name &
Date: _____________
Appointment, OIC Parent Polyclinic)
Notes :-
This original receipt is required to be returned at the time of collection of Smart
1. Card (s). Receipt will not be destroyed. This will be filed along with the original
Application Form.
No Smart Card will be issued if this receipt in original is not produced and final
2.
verification by Central Org ECHS.
Record Office will retain this receipt after checking the Application Form till
3.
retirement 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
5.
for old retirees who are not in possession of old Cards.
The Original Receipt is valid up to a maximum of SIX MONTHS from the date of
6.
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: 03 Oct 2023

Signature of ESM / Family Pensioner