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Application Form For Medical Advance: Department of Posts India

This document is an application form for a medical advance from the Department of Posts India. It requests information such as the name and designation of the government employee, their current pay, the name and relationship of the patient, the nature of the illness, the amount of advance required, whether any previous advances have been taken for the same purpose, and the office the employee is attached to. It needs to be signed by the applicant and certified by the superintendent or incharge of the hospital, with details on the patient's illness, expected duration of stay, and anticipated treatment costs.

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Chandrakant Singh
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2K views1 page

Application Form For Medical Advance: Department of Posts India

This document is an application form for a medical advance from the Department of Posts India. It requests information such as the name and designation of the government employee, their current pay, the name and relationship of the patient, the nature of the illness, the amount of advance required, whether any previous advances have been taken for the same purpose, and the office the employee is attached to. It needs to be signed by the applicant and certified by the superintendent or incharge of the hospital, with details on the patient's illness, expected duration of stay, and anticipated treatment costs.

Uploaded by

Chandrakant Singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DEPARTMENT OF POSTS INDIA

APPLICATION FORM FOR MEDICAL ADVANCE

1. Name and Designation of the Government Servant:

2. Present Pay as defined in FR-9 (21):

3. Name of the patient and relationship with employee:

4. Nature of illness:

5. Amount of advance required:

6. Whether any advance for the same purpose was taken


previously:
7. Whether Permanent / QP

8. Office to which attached:

9. Whether security is furnished, in the case of temporary:

Dated: Signature of the Applicant

Certified that the patient Shri / Smt _________________________________________


wife / son / daughter of Shri _______________________________________________
employed in the office of __________________________________________________
is being treated as an Indoor / Outdoor patient, is suffering from __________________
__________________________. The probable duration of stay of the patient in the Hospital
will be _____ days and anticipated cost of Rs. _____________________ under CS (MA)
Rules as amended from time to time.

Certified that the patient has recognizable chance to recovery is treated otherwise than a
patient in the recognized TB Institution.

Countersigned
Signature of the Suptdt./
Incharge of the hospital
with Seal. Signature of A.M.A.

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