Shaukat Khanum Memorial Cancer Hospital And Research Cancer Hospital

Collection Center Card Request Form

TO TODAYS DATE EMP. NAME CNIC # CONTACT # DESIGNATION COLLECTION CENTER # DATE OF JOINING EMPLOYEE #

: : : : : : : : :

HOSPITAL SERVICES MARKETING May 31, 2012 Syed Farhan Shah 34201-0339847-7 03436245600 Manager 8 2000
To be filled in by HSM

Picture

Verified that the contents of the above information are true and correct to the best of my knowledge and belief and nothing has been concealed therein. Syed Shah Farhan

Employees Signature :

____________________________
Collection Center Head

Dr Abdul Sattar : ____________________________

(Franchisee/Supervisor)
Hospital Services Marketing : ____________________________

Note: Attachment of CNIC copy is mandatory for every applicant.