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KENDRIYA VIDYALAYA SANGATHAN
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Under Minstry of Education, Government of lndia
sftra*rqi?Iq - tEllldrq, Regional Offrce - Hyderabad
frh-c,ftiarrErc I picket, sEcuNDERABAD- 500 009
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f O.S: 040-27 84 564 9 lDCl 27 847 24s lAOl 27 UO 1 22 l (,j
E-mail: dchyderabad@yahoo.Com Website: www.kvsrohvd o rq
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hcqr : Renewarirssue of fresh cards to Retired Emproyees of KVS- reg.
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With reference to the subject cited above, please find enclosed herewith the list of
enclosures to be submitted for New CGHS card in respect of pensloners.
The list of enclosures may be submitted along with the check list of KVS(Ro)Hyd
and proof of the amount credited either through ONLINE MODE or DD. The details of the
Account of KVS(RO)Hyderabad for remittance of amount through online mode is given below
:
Name of Account : KVS RO ACCOUNT
No.
A,/c : 2620101003967
IFSC Code : CNR80002620
BanK : CANARA BANK CANTONMENT BRANCH.
This office is facing lot of difficulty in processing the cards as the pensioners are not
submitting the requisite documents. lt may also bo brought to th€ notic€ of the pensionors
that for renewal of CGHS cards the following documents need to be submitted:
1. DDi Proof of Online remittance of amount.
2. Copy of the paper card containing the beneficiary id issued by CGHS after retirement.
ln case copy of paper card is not available copy of GGHS card may be submitted.
(However without bon€ficiary id tho card cannot be downloaded)
The request for renewal may bo s6nt one month in advance, as the entire procoss takes
time. The pensioners may be requested to update the mobile numbers in case the numbers
are changed as the renewed cards are to be downloaded from the website www.cghs.nic.in
and the OTP comes to the registered mobile number.
Thls offlce roqulres 01 week's tlme to procoss th6 applicatlons for lssue of fresh cards/for renewal of
cards as the offico has to genorate challan through Onllno portal of Bharat Kosh and remlt th6
amount ln Bank and update the UTR Number ln the online portal for generatlon of provislonal
receipt Thls provislonal rec€lpt wlll be s€nt to the Additlonal Dlrector , CGHS Begumpst along
wlth tho spplicstlons for renewaUlssuo of fresh cards. Hence it is not possible to sond the
appllcatlon of €ach indivldual pensloner on dally basls .
All the Principals are requested to circulate the above information to the Pensioners and
also a copy of the list of enclosures may be kept on the notice board of the Vidyalaya for
ready reference and also displayed in the website of the KV.
Yours faithful ly,
Encl: As stated.
(K, ENDRAN)
DEPUry COMMISSIONER
Copy for information to :
1. Shri. V. Satyanarayana, Education Officer (Retd) , President, KVS Retired Employees
Association, 186, Vasavi Nagar, Kharkana, Secunderabad-soo 015 -for information'
2.Shri.V.Jayabal,Sect,KVSREA,4O3,GruhasiriPride,JVColony,Gachibowli,Hyd-032
Check List
SNo. Particulars Fill in the column leqible
1 Name of Beneficiary
2 Designation at the time of Retirement
2 KV from where Retired
4 Date of Retirement
5 (a) Whether holding CGHS Card on the date
of retirement
5 (b) CGHS Card Number
5 (c) Place of Dispensary / Wellness Centre.
6 On line application for issue of New
CGHS beneficiary card.
7 CGHS Card Surrender Certificate
8 Copy of Last Pay Certificate
o Copy of Pension Payment Order
10 (a) Copy of letter addressed to Manager,
SBl, New Delhi for release of Pension
(ln case opted for CGHS facility and no
claim of Fixed Medical Allowanc).
10 (b) Letter for Stoppage of Fixed Medical
Allowance (ln case 10(a) is not applicable
11 Demand Draft
12 Two sets of Pass-port size photographs
(One to be affixed in online application
and other to be separately enclosed.
13 Self Attested Copy of Aadhar Card
14 Dependents of Retired Employee, if any
(Enclose documentary proof)
15 Whether spouse availing Medical
facilities from Govt Dept. if so details
16 Mobile Number
17 Any other relevant lnformation.
(Signature of Retired Employee)
Date:_
PROFORMA FOR OBTAINING CGHS BENEFICIARY CARD FOR AVAILIN G MEDICAL
FACILITIES FO R RETIRED EMPLOYEES OF KVS RO/KVs IN HYDERABAD AND
SECU DERABAD WHO WERE HOLDIN CGHS CARD AT THE TIME OF RETIREMENT
S Particulars Details to be furnished in Cap. letters
No
1 Name of the Retired Employee
2 Designation
Name of the KVS RO/KV from
where retired.
4 Date of Retirement
5 Basic Pay / Grade Pay at the time
of retirement
b Pension Order No. & Date (Copv to
be lhe enclosed)
7 Amount of Medical Allowance
drawn alongwith Pension.
o
GPF or CPF Optee GPF I CPF
o Name & Branch of the Pension
disbursement Bank
10 Certificate from Pension
Disbursement Bank - Stopoase of
Fixed Medical Allowance.
11 Permanent Add ress declared in
Pension Papers.
12 P resent Add res s (4!!r eSSltppI=
copy lo be enclosed)
13 Old CGHS beneficiary Card No. &
Dispensary No. Card No. Disp. No.
14 Surrender Certificate/letter of
CGHS Card to be enclosed
15 Details of dependent family S Name DOB/Age Relation
members as on date. (Name, Date No shi
of Birth/Age & Relationship) /capy
ofDOB proof to be enclosed)
'16 Computer generated application
for Registration. No. dated
17 Two Passport slze Photographs of One Photograph to be affixed with the
Self and Dependents computer generated application & onother to
be enclosed.
18 Demand Draft for Rs
being the advance payment for DDNo, Date_
annual subscription in favour of
" Ke ndriy a Vitly al ay a S angat lt tn,
Re eio n a I Oflice, Hyde ra b ad ".
19 Any other information
Ivofej Ir,e CGfrS beneficiary Card should be renewed within 30 davs before expirv.
I hereby give an under taking that I shall avail the medical facilities through CGHS. I
agree to forgo the monthly Medical Allowance in lieu and pay yearly subscription for issue of
CGHS beneficiary card and will not request for any change in the procedure later on. The
information submitted above is true to the best of my knowledge and belief.
Signature of the Pensioner
Date:
ENCLOSURES TO BE SUBMITTED FOR NEW CGHS CARD
**Visit www.cshs.nic.in website. Click on APPTY PLASTIC CARDS. Enter Mobile Number and generate
OTP. Enter the OTP and click on Verify. Select "New Em ployees/Pensione rs" to apply for New CGHS Card
and "Existing CGHS Beneficiaries" to apply for Plastlc Cards. Fill the necessary details and take a printout.
Service:
1. onlineApplication**
2. Appointment Order copy/ Movement order copy (if transferred from other cities)/ Service
Certificate.
3. Latest pay slip
4. Form-3/Family details copy
5. Residence proof (Aadhar/PAN card copy) for main applicant and dependant(s).
5. Two (2) individual passport size photographs each.
Pensioners:
1) online Application**
2) Last Pay Certificate
3) Xerox copy of Pension Payment Order with Gazetted attestation on each page.
4) Certificate for Non-drawal of Fixed Medical Allowance (original to be submitted).
s) OriginalSurrender certificate of previous health card.
a)Original IDA to CDA Pay Conversion letter (for BSNL Pensioners Only)
6) Printout of Online Payment Receipt.
7) Any Govt. lD proof Xerox copy (Aadha r/PAN/Voter) of main applicant and dependant(s)
8) Two (2) individual passport size photographs each.
* For inclusion of Parents/Parents-in-law as dependants, A Legal Affidavit by the main
applicant, lncome certificate issued by MRO and Proof of residence of dependant(s) to be
submitted.
* For inclusion of Widow Siste rs/Da ughte rs, Death certificate of husband, A LegalAffidavit by
the main applicant, lncome certificate issued by MRO and Proof of residence of
dependant(s) to be submitted.
+ For inclusion of Divorcee Daughter/sister, Divorce Decree, A LegalAffidavit by the main
applicant, lncome certificate issued by MRO and Proof of residence of dependant(s) to be
submitted.
) Applicant should come in person lvith the above enclosures to submit the Application.
!'recdonr Fighters:
1. Online Application * *
2. Xerox copy of Pension Payment Order with Gazetted attestation on each page.
3. Xerox iopy of Railway Pass.
4. Residence proof (Aadhar/PAN card)
5. Two (2) individual passport size photographs each.
) Applicant should come in person with the above enclosures to submit the Application.
Famih'Pensioners:
1. Covering Letter by Family Pensioner.
2. Copy of Death Certificate of Main card holder.
3. Xerox copy of Pension Payment Order with Gazetted attestation on each page.
4. Bank passbook Xerox and three (3) months' bank statement.
5. OriginalCGHS card to be submitted.
6. Any Govt. lD proof (Aadhaar/PAN/Voter lD) Xeroxcopy.
7. Two (2) individual passport size photographs.
> Applicant should come in person with the above enclosures to submit the Application.
