29/11/2022, 08:01 oe ONLINE APPLICATION FOR SWASTHYA SATHI Bray HTat AR 8 HAA A PHT ASA, APONTH HASTA Help Line No: 18003455384 (Toll Free) Data is submitted successfully, Please keep your registration no. 91910017000200001598378490397 for all future communication. DISTRICT: * NADIA IBLOCK/MUNICIPALITY: * Block BLOCK: * Haringhata v VILLAGE: * BAHIR SONAKHALL ¥ RESIDENTIAL ADDRESS: * BAAER SONAKHALE PO-PANPUR sT-NADTA PINCODE: * 741249 DEPARTMENT (IF PLOYE OFFICE NAME & ADDRESS: (IF APPLICANT OR ANY MEMBER IS EMPLOYED) EMBER(S) OF FAMILY ARE Both Male & Female ¥ CATEGORY: othor Backward Caste (OBC) ¥ PANCHAYAT: giroyny INAME OF THE APPLICANT: * TANVI SULTANA IHOF NAME (FATHERISPOUSE) MD MONNAF HOSSAIN MALLICK DO ANY MEMBER OF THE FAMILY RECEIVE GOVT. SPONSORED HEALTH INSURANCE/ASSURANCE: * NO v DO ANY MEMBER OF THE FAMILY RECEIVE MEDICAL ALLOWANCE FROM GOVERNMENT: * NO v DO ANY MEMBER OF THE FAMILY RECEIVE MEDICAL ALLOWANCE, FROM PRIVATE: * NO ¥ Member List TANVI SULTANA MD > MONNAF | suse 2 |e MONNAE |spouse 32. [Male MALLICK, BENIFICIARY|25 Female 573084063245 “miTs7735s) Unemployed 6297071571 Selfemployed 9735478081 |{ Eat ]|[ Delete ‘Add New Member (*) indicates All Fields are mandatory Please update all fields If the member is not existing please delete that member Check the family details in ease any modification required please update that hitps:faccounts.swasthyasath.gov.in'SSExtendedBenefcianyRegistation aspx 12