स्वास्थ्य समिति मेवाड़ संघ मुम्बई | स्वास्थ्य कार्ड
Family Member*
Registration No*
(Mewad Sangh / Mahila Mandal)
Upsangh*
Village Name*
Sur Name*
First Name*
Last Name*
Passport Size Photo*
Gotra*
Blood Group*
Select Blood Group
A Positive (A+)
A Negative (A-)
B Positive (B+)
B Negative (B-)
AB Positive (AB+)
AB Negative (AB-)
O Positive (O+)
O Negative (O-)
Date of Birth*
Gender*
Select Gender
Male
Female
Other
Mobile No.*
Emergency Contact.*
Any Medical Condition, if Yes (Please Specify)
Aadhaar Number*
Address*
Pincode*
Office Address*
Eye Donations*
Select
Yes
No
Organ Donations*
Select
Yes
No
Do you have Mediclaim ? *
Select
Yes
No
Submit
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