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Health Cards
Health Cards Links: Data Needed to fill Enrollment Form Health Insurance Latest G.O's RSBY NHIS

Health Cards Online Application - Data Needed for Filling Enrolment Application Form

The Following Information is needed to fill Health Cards Enrollment Application Form.
Data needed for filling Enrollment Application Form
Personal Details
Employee ID* Obtain the employee code given by DTA
PPO number* If you are a pensioner obtain the PPO number
Name* Write down the name as it appears in your service register
Aadhar Number* Write the Aadhar Number as it appears in your card
Aadhar Enrollment Number* Write the Aadhar enrollment ID as it appears in the acknowledgement Slip given at the time of Aadhar enrollment
DOB* Write DOB as it appears in your service register
Sex* Write your Gender
Marital Status* Write your present marital status
Date of Retirement* If you are retired,write down the date on which you retired
Community* Write the community to which you belong to
Disability Details* If you are disabled, write down the type of disability and percentage of disability
Nationality* Write you Nationality
Contact Details
Address* Write your complete residential address, location, email address and mobile phone number .Note that your email and mobile phone number have to be carefully written as you will be communicated through these modes.
Identification Details
Ration Card number If you hold a ration card, write down your ration card number. Ration card number will make tracking your cases easier and quicker for us. Therefore don't forget to inform the number in case you have one.
Identification marks* Write two visible identification marks such as moles with exact location on your body.
Posting Details
HOD* Write your Head of the Department
District* Write the district where you are currently posted
DDO code* Obtain the DDO code of DTA where you are currently receiving your pay.
Post* Write your current category of post. Ex: Civil Assistant Surgeon, Kamati, Driver, etc.
STO/APPO* If you are a pensioner, obtain the STO/APPO code and name of office from where you are receiving your pension.
Pay Details
Current Pay Write down you current pay.
Attachments needed
Service Register* Obtain a scanned softcopy of the first two pages of the service register
Photo* Obtain an ICAO compliant passport photo of self and each dependent family member in softcopy. ICAO compliant photo is one which we submit while applying for Passports. Tell your photographer beforehand about this requirement.
Aadhar card* Scan a copy of either your Aadhar Card or the Aadhar acknowledgement slip with the details clearly visible.
DPB certificate* If any of your dependents is less than 5 years of age and does not have an Aadhar number, then prepare a scanned soft copy of his date of birth certificate.
Disabled certificate* If any of the members is disabled, then prepare a scanned soft copy of the disability certificate.
Family member details
Name, relationship, aadhar number* Write the name, relationship with your, Aadhar number or Aadhar enrolment ID number of each of your dependents.
Signed application form with declaration* After you enter all the details in the e-form, you need to print it and sign the form. Scan the form and prepare a soft copy. The declaration says that , you declare that (1) you agree to the entire Aadhar data of your family to be transferred to AHCT, (2) you are liable for disciplinary action for declaring ineligible family members as dependents, and (3) the information submitted is as per your service register and true to the best of your knowledge.




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