AMRITA

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VISHWA VIDYAPE ETHAM

UNIVERSITY
Established

u/s-3 of the

UGC Act 1956

Amrita Institute of Medical Sciences

Healthcare, Education

&

Research

2210712016

To Whomsoever

It Mav Concern

This is to certifu that Mr. T. S. Sukumaran, (AIMS MRD: 1717196), 39 yeat I male, is
a diagnosed to have Severe Aplastic Anemia. This is a life threatening disease with very

high risk of severe infections and major bleeding. He requires Allogeneic Stem Cell
Tranplantation from a suitable donor on urgent basis. The approximate cost of therapy is
Rs. 30 Lakhs.

,/
Dr. Raghuveer Prabhu. S,
Associate Professor of Haematology,
Dept of Medical Oncology & Haematology
Amrita Institute of Medical Sciences
AIMS Ponnekara P.O., Cochin- 682 041

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AMRITAPURIOBANGALOREOCOIMBATOREOKOCHIaMYSoRE
AfMS ponekkara p,o. Kochi. Kerala 682 041. phone: +91-4g4-2g01234. Fax: +91,484-2802120. Websiter wwwaimshospital.org, H'mail: md@aims.amrita.edu

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FORM iOC
(See Rule 3)

GOVERNMENI OF KERALA
KANJIKKUZHI VILLAGE OFFICE

INCOME CERTIFICATE
No.19163976

Date:

4410712016

Certified that the Annual Family Income of the per-son with the details mentioned below from ali source is

9000 (Rupees nine thousand only

iJame of Peison to whom certificate is

issued

SUKUMAP.AN

Gender

Male

Age

?o

Name cf Father

SREEDHARAN

A.ddr--ss

THEKKEKKUTT, 33. KANJIKHZY

Post Office with Pln code

KANJIKUZHY, 685606

Name of Localbody

lCukki Kanjikuzhy

Viliage

Kanjikkuzhi

Taluk

Idukki

District

Idukki

Certificate lssued Date

04107t2016

Designation of the lssuing officer

VO

Purpose for which the certificate is issued for

AMRUTHAHOSPITALENM

This certificate is issued based on the detaiis given in the application, Iocal enquiry, facts and records produced.

Security Code : 4BYQ2

valid n
/r

Signature

gita y s g n ed,{yff SAT H yAN

Date: 201 6.07.0XIf,6:01 : I 3 tST
D

NOTE:

1.

ThisdigitailvsigneddocumentislegallyvairdasperthelnformarionTechnotogy

(lT)Act,2000.

Authenticity of this document can be verifled from http://edistrict.kerala.gov.in/ and submitting the Certiflcate
Number and
Security code. Alternatively, please call the numbers 155300(from BSNL landline), 047.1 155300(from BSNL mobile),
447123355231a47i21150941047121'1sog8(from
other neiworks) and quote the Certificate Number to the operator.

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K'TTAYAM
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OUT. PATIENT TICKET

Medical Co!lege Hospital, Kottayam

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