Card# Will be Autogenerated 11 Digit
Name
Date of birth   
Gender Male
Issue Date 20 Apr 2019

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Apply Online For Health Card
Apply Online For Health Card / स्वास्थ्य कार्ड के लिए ऑनलाइन आवेदन करें * अनिवार्य फिल्डस (Mandatory fields)
Name / नाम *
Father Name / पिता का नाम
Date of Birth / जन्म दिनांक * (dd-Mon-yyyy) / /
( As per high school certificate in 'dd-Mon-yyyy' format. i.e. '01-Jan-1990' )
Gender / लिंग *
Mobile / मोबाइल *
Address / पता *
Upload Photo / फोटो अपलोड करें *

( JPG,JPEG,GIF,PNG image with size upto 50 KB )
Upload Student Signature / छात्र के हस्ताक्षर अपलोड करें *

( JPG,JPEG,GIF,PNG image with size upto 50 KB )
Captcha *
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