Industry Name
Name of Health Care Establishment
Name of Local Body
*: |
(max 250
characters) |
HCF/CBWTF Type*:
|
|
Industry Address(Plot No./Village Name./ Patwari Halka No.)
Address
Office Address
*: |
|
Area
*: |
|
City:* |
|
Pin Code*: |
(max 6 digits)
|
District:* |
|
Jurisdiction Area:
Tehsil: * |
|
Category:
Classification of Local Body:
* |
Please select the Category
Please select the Category
Please select classification of Local Body
|
Industry Type:*
Ownership Of Health Care Establishment:*
Class of Local Body:*
|
Please choose category to populate the Industry Type
Please choose category to populate Ownership Of Health Care Establishment
Please choose classification of Local Body to populate class of Local Body
(enter other industry type name, max 250 characters)
|
Scale of Industry*: |
|
Industry Status*:
Hospital Status*:
|
|
Commissioning
Month And Year
Date of Establishment (Month And Year)
*: |
e.g.
2002 |
Industry Registration/License No.:
Population of Local Body (as per last Census)*:
|
|
Total Capital Investment without Depreciation / Project Cost(Rs in Lakhs) *:
No.Of Beds *:
No.of beds/patients per month *:
Average No.Of Samples per year *:
Average No.Of Animals per month *:
Average No.Of Patients per month *:
No.Of Chairs *:
|
|
Capital Investment of Plant & Machinery without Depreciation*: |
(Rs in Lakhs)
|
Ownership of Industry: |
|
Whether Cess Paying : |
|
Landline Number :" |
|
Fax No. With Code : |
|
e-mail Address*: |
|