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TN-GJ65766942003826V

INDIA NON UDICIAL


Government of Gujarat
Certificate of Stamp Duty

Certificate No. IN-GJS57G6942003826V


Certificate Issued Date 25-Oci-2025 05:14 PM
Account Reference CSCACC (GV)/ gicscea07/ GJ-CUSOY0551/ GJ-Cæ

Unicue Doc. Reference SUBIN-GJGJCSCEGO755438408113764V

Purchased by ORSANG HOSPITAL

Description of Document Article 5(h) Agreement (not otherwise provided for)


Description Not Applicabie
Consideration Price (Rs.)
(Zero)

First Party ORSANG HOSP!TAL

Second Party Not Applicable

Stamp Duty Paid By ORSANG HOSPITAL

Stamp Duty Amount(Rs.) 300


(Three Huncired only)

OTAC.N JOSHI
NDIA)
Area Baroda ist
Regd.no. 101/94 MICO
Valid Up T
16/05/2028 (o CHHOTAUDSPU

ouIAR Soeb

IE 0014142086
ati i p c f Stock clotdg

M.B.B.S, M.s.(Orthopaedics)
C.NJOSHI Reg. No.G-20168
INOIA
Area Barcda Dist ORSÄNG HOSPITAL
Regd.na. 101/94 BEFORE M:
vaiie UpTo
18/05/2028 8619

GUJARA
TAUO
terms
(Dr.Manish basis.
hospital not through are
from per
are above DR.
JITENDRA
RATHVA
M.B.B.S,
M.S.(Orthopaedics)
cashless
facilities/Pharmacy/Catering/Laundry/Lithotripsy
unit which same
notarized as our basis ORSNG
HOSPITAL
CENER stated Rog.
No.G-24166
That in the
services cashless
on available
PMJAY. understandingAttestor.
contents &088
with BLOODpatients 8619
HOSPITAL
Franking
Bharat not
provide on
guideline) patient the L0
AYUSH schemne are follows:
to all
Ayushman which Vidja) after B01
paper/ scheme that
to as NBTC who attested.
THE stamp
;
Rathva
with
services Manish
services are centre
Place:
Chhotaudepur
and
;BATE
MOU servicesper the Place:
Chhotaudepur
OF and
(as by Hence
explained
ndepneoyyo)
Mijal165. yojana (Dr. to
100 HOSPITAL provide
provide COMPONENTS provided issued
AGREEMENT basis. CENTERup
2023. BEFORE
M.
Rs. Chhotaudepur.3gË tied
Slo: vatsalya" letter and C.N
JOSHI
on different. to and cashless of be of
OF
furnished :-35/male, ORSANG hospital
facilitate BLOODdetails will
overOctober
QUIAR
diagnostic tie-up
"MA on BLOOD read
services
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are our unit AYUSH The submitting 26th
be age Hospital, of &
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to
hospital.
AND
are
parties. follows: Proprietor by agreedfor this
to up up
mentioned affidavit
affidavit( Rathva
tied
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about Jitendra
if
separately
of hospital

as
Orsang
oath the
am

agreed centrewith
implement
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to MOUit through
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in 1.

BLOOD
haveavailable
above

tie
mentioned
herewith
and
correct..
trueDate:3810/
2023
of

on
me
content
before
Attestation:
AOTAA 101/94Regd.18/no.05/2024
Date:2G/10/2023
Dist
Barcda
JOSHI
C.N
Area
ToUpvaiio
Format At on I Vidja) Further above
are
signed
Dr. Rlo: state That We The We The
of
OTA
Prnt Dete: 17/022022 e u Dt 15022013
Vadodara,
Gujarat,Address:
391160faliya,391160
JYlt,
aslE,sl, iß
OTAEY
1947 khndiya
S/0: SIO:
Rathva
amadara, 16l eoverir

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9382
2260
2791 Manilal, HQIG, 9382
2260
2791
helpP@uldai.gov.in Khandiya DOB:06/07/1988
9347Maie IluYoHRathva
277, Jitendrakumar
277,
Amadara,Patel

ottndia
www.uldal.goN.in
asThecharged It to on
Date:26/10/2023 is T OCC: Dr.
scheme have oath
per Manish
bills agreed Doctor
agreed 1. entered as
for any beneficiaries follows:
above money that Vidja
terms BLOOD in R/o
the to AGREEMENT
(AYUSH
services scheme Vasna
and for MOU
above AND on
conditions. with -BLOOD
cashless Bhayli,
Chhotaudepur
Place: will patients BLOOD the
be any Orsang BY
submitted services. basis.
VadodaraCENTER)
THE
COMPONENT
referred
Hospital TIED-UP
to to do
s/o
the us Durlabhjibhai,
hereby
to
Orsang by (as provide FACILITY
Orsang
per solemnly
Hospital NBTC the age
Hospital
Signature. following
guideline) affirm 37,
for
payment wil services and
not
state
be

S/Lic.No.
DoD \GB/204

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