WEST BENGAL HEALTH SCHEME

FORM FOR ISSUEING DIGITAL CERTIFICATE (UPDATED), PENSIONER

1. Name of Pensioner with Designation:

2. Basic Pension (ROPA-2019) and monthly income:

3. Aadhar Card No (self):

4. E-mail id (self, if any):

5. Mobile No(s):

6. PPO ID & Name of Treasury /e-mail id of Bank:

7. Bank Account No with IFS code:

8. Any other information:

9. Name of Beneficiaries with Aadhar Card Number and Monthly Income

Signature with Date