Membership Registration - P.M.C.H.S. Union (U.P.)

Form Break Up

This Form Contains 4 Sections

1. 1. Personal Details
  2. Educational Details
  3. Professional Details
  4. PMCHS Association Details

At the end you are provided with a Grievance Box where you can write your query if you have any while filling the form.
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Section 1: Personal Details

Full Name *

Father's Name

Husband's Name

Gender *

Date of Birth *

Phone Number *

Alternate Phone Number

Email *

Permanent Residential Address *

If Permanent Address is same as Correspondence Address

Take or Upload Your Photo * (Max 5MB, PNG/JPG)

Section 2: Educational Details

Note: Select at least one qualification. Subfields are mandatory if selected.

What have you qualified? * (Select at least one)

UG Degree PG Diploma PG Degree PhD

You have completed (PG Diploma) in? *

List-1 (PG Diploma) Specialities *

You have completed (PG Degree) in? *

Select Specialization of (PG Degree) Ayurveda *

M.D.-Ayurveda Specialization *

Select Specialization (PG Degree) Unani *

Section 3: Professional Details

Note: PDF uploads are mandatory for Niykti Patra and Prrabhar Praman Patra (Max 5MB).

What is your e-HRMS code? *

Choose Your Posting District *

Choose Your Health Center *

Location of Your Health Center *

Currently attached to Center (If applicable)

Attach your Niykti Patra (Appointment Letter - Issued by Ayush Anubhag -1) * (Max 5MB, PDF)

Click or drag PDF here (Max 5MB)

Date of Appointment (Niykti Tithi) *

Attach your Prrabhar Praman Patra (Charge Certificate) * (Max 5MB, PDF)

Click or drag PDF here (Max 5MB)

Date of First Joining in Department (Prrabhar Grahan ki Tithi) *

Section 4: P.M.C.H.S.U. Details

This section is optional.

Level of Responsibility

Position Occupied

Membership Payment Details (Max 5MB, JPG/PNG/PDF)

Click or drag file here (Max 5MB)

Upload Payment Receipt (Screenshot of UPI Transaction, Max 5MB, JPG/PNG)

Click or drag file here (Max 5MB)

Grievance Box (Suggestions)

Registration - P.M.C.H.S. Association (U.P.)

Form Break Up

Section 1: Personal Details

Section 2: Educational Details

Section 3: Professional Details

Section 4: P.M.C.H.S.U. Details

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