Online payment Form





Name of participating entity (Organization/Individual)

Address

Category

Project Title

Phone

Email

Type of entity (tick one)

Public sector hospital
Private Hospital > 50 beds
Small Health care Organization <= 50 beds
Diagnostic center (Stand alone Pathology & Radiology centers)
Technology provider / Medical Equipment Manufacturer /Distributors
Health Insurance Company
Individual (Self or on behalf of an Organization)
NGO's / Non Profit Organizations
Others


Corporate or other Group or Parent company to which the participating entity belongs, if any






Processing Fees
• Private Sector (includes Hospital / Diagnostic Center / Medical Equipment / Technology Provider etc): Rs 15000/
• Public Sector Hospital: Rs 6000/
• Small Health care Organization <= 50 beds: Rs 6000/
• NGO’s (to pay 6000/-)
• Others (to pay 15000/-)

Note:
• Processing fees can also be deposited as Demand Draft payable at New Delhi/Cheque payable at par in favor of FICCI, payable at New Delhi.