Polyclinic File ref:_____________________
To
OIC ECHS Polyclinic
_____________________________________
_____________________________________
_____________________________________(Address of Old Parent Polyclinic)
1. ECHS Card No _____________________________________
2. Name of ECHS beneficiary _____________________________________
3. Relationship with ECHS Member _____________________________________
4. No _____________________________________
5. Rank _____________________________________
6. Name of AFV _____________________________________
7. Old Parent Polyclinic _____________________________________
8. New Parent Polyclinic _____________________________________
9. Date of change of parent Polyclinic _____________________________________
10. Duration from ______________________________ to _________________________________
Date:
Date:
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Admin
COMMENTS
Sub: request to change of Parents Polyclinic one state to home state.
Sir, my present polyclinic in Jamnagar station head quarter. Request for Transfer out and request for in. the new polyclinic in army base PALAMPUR HOLTA. my name is ISHWAR SINGH. EX INDIAN NAVY.CARD NO. AH 0000 0423 2038. WIFE NAME SUDERSHNA RANA.CARD NO. AH 0000 0423 2114.
Therefore you are Requested kindly do the needful.
Thanking You
ISHWAR SINGH EX. INDIAN NAVY
MOB.9427276627