Name of the hospital.
Please provide your full address.
Please mention your zipcode.
Kindly upload hospital logo.
To whom we will be in contact.
Contact person's phone number.
Authorized person's position in the hospital.
Hospital's official email id.
Mention your Bank Name.
Mention bank account holders's full name.
Please indicate your account number.
Confirm your account number by re-entering .
Mention your bank IFSC code .
Upload hospital bank acount details in hospital letter head with stamp & signature.