Online Member Registration Form

  • NOTE :
    1. Along with the Registration Charges an advance for 6 months is payable Online.
  • 2. Once the Request form is submitted in STEP 1, The Service route and other verification is done by our staff then only you can make The Online payment using STEP 2.
  • 3. The Membership shall be subjected to the Admins' approval after the form submission and if any data is found incorrect / False, upon verification, the membership shall be Rejected/Suspended.

STEP 1: Fill in the Form and Click "SUBMIT NEW REGISTRATION" button.
Name of The Institution / Party *
Select City & Zone *
Institution Type * (Please select the closest option to avoid further problems)
No. of Beds / Rooms / Chairs as applicable
Note : A Basic Material Package is mandatory for new registration of any Institute / Clinic / Pathology.
The Amount is payable in advance with the Registration Fee.
Registration Charge (One Time) *
Monlthy Rates per unit *
Monthly Charge per Month*
Total Payable Amount*
Address *
Pincode
Mobile No. (Do not use 0 or +91) *
Email *
Contact Person *
Owner Name
Adhaar#
GSTN
Payment Mode *
* Mandatory Fields
STEP 2: To make An Online payment for the Approved Registration Request
Click "Make Online Payment" Button.