Forms

This section is a repository of important Application Forms of Central/State/UT Governments which are required to be filled up and submitted for availing different services and applying for obtaining important certificates/licences pertaining to this sector.

Date Wise | Alphabetically

Central

Issue of Individual Plastic Cards for CGHS Beneficiaries (20 KB) (PDF file that opens in a new window)
Application Form for Central Government Health Scheme (CGHS) Card for Pensioners of Central Government (61 KB) (PDF file that opens in a new window)

State

Forms related to state departments
State	Forms
Andaman and Nicobar Island	Application Form for Registration of Beneficiary under Planned Families Scheme (24 KB) (PDF file that opens in a new window) Application Form for Medical Fitness Certificate (42 KB) (PDF file that opens in a new window) Application Form for Registration or Renewal of Genetic Centre or Laboratory or Clinic (External website that opens in a new window) Application Form for Grant or Renewal of Licence (43 KB) (PDF file that opens in a new window) Application Form for Registration of Birth. (External website that opens in a new window) Application Form for Registration of Death (External website that opens in a new window) Application Form for Grant or Renewal of Licence under Prevention of Food Adulteration Act (External website that opens in a new window) Application Form for Reporting Still Birth. (External website that opens in a new window)
Andhra Pradesh	Proforma for Death Report (158 KB) (PDF file that opens in a new window) Monthly Progress Report on Screening of Blood (8 KB) (PDF file that opens in a new window) Monthly Progress Report on Voluntary Counselling And Testing Center(VCTC) (6 KB) (PDF file that opens in a new window) Monthly Progress Report on STDs (13 KB) (PDF file that opens in a new window) Monthly Progress Report of District (11 KB) (PDF file that opens in a new window) Review Formats on Family Welfare (8 KB) (PDF file that opens in a new window) Licence to Manufacture for Sale of Ayurveda/Siddha/Unani Drugs (8 KB) (PDF file that opens in a new window) Application for the Grant or Renewal of a Licence to Manufacture for Sale of Homeopathic Medicines (5 KB) (PDF file that opens in a new window) Application For Approval of Technical Staff (8 KB) (PDF file that opens in a new window) Health Register (78 KB) (PDF file that opens in a new window) Application Form For Strengthening of Eye Bank or Eye Donation Centre (132 KB) (PDF file that opens in a new window) Andhra Pradesh Vaidya Vidhana Parishad Option Form (25 KB) (PDF file that opens in a new window) Proforma-cum-Requisition for Seeking Financial Assistance for Medical Treatment/Exgratia Under Chief Minister Relief Fund (17 KB) (PDF file that opens in a new window)
Arunachal Pradesh	Group Insurance Scheme Medical Certificate: fitness (6 KB) (PDF file that opens in a new window) Refund of Medical Expenses (7 KB) (PDF file that opens in a new window) E-form for claiming Medical Expenses of Goverment Servants and their families (116 KB) (PDF file that opens in a new window) Form of Application for new Water Connection (310 KB) (PDF file that opens in a new window) Application for Restoration of Name in the Register (399 KB) (PDF file that opens in a new window) Application form for Direct Registration under Arunachal Pradesh Medical Council (APMC) (455 KB) (PDF file that opens in a new window) Application Form for Drugs Licence (397 KB) (PDF file that opens in a new window) Application Form for Continuation of Name in the Register under Arunachal Pradesh Medical Council (409 KB) (PDF file that opens in a new window) Application for Registration of Additional Qualifications under Arunachal Pradesh Medical Council (401 KB) (PDF file that opens in a new window)
Chandigarh	Medical Report for Examination of Candidates for Gazetted Services (89 KB) (PDF file that opens in a new window) Application for Sterilization Operation and Consent Form (90 KB) (PDF file that opens in a new window) Medical Termination of Pregnancy (57 KB) (PDF file that opens in a new window) Grant or Renewal of a Licence to Sell, Stock or Exhibit for Sale or Distribution of Drugs (176 KB) (PDF file that opens in a new window) Grant/Renewal of Licence for Selling of Food Articles (209 KB) (PDF file that opens in a new window) Report of the Birth (85 KB) (PDF file that opens in a new window)
Delhi	Form for Journalist Health Card (20 KB) (PDF file that opens in a new window) Nursing Home Registration Form Forms For Authorisation For Health Care Units (External website that opens in a new window)
Goa	Request for Private Attendance (23 KB) (PDF file that opens in a new window) Application for Fitness Certificate (6 KB) (PDF file that opens in a new window)
Gujarat	Application for financial assistance for disabled under Sant Surdas Yojna (1 MB) (PDF file that opens in a new window) Health Package Scheme for Scheduled Castes (822 KB) (PDF file that opens in a new window) Health Licence Application Form - Vadodara (50 KB) (PDF file that opens in a new window)
Himachal Pradesh	Requisition for Irrigation Water (11 KB) (PDF file that opens in a new window) Adverse Drugs Reaction Reporting Form (711 KB) (PDF file that opens in a new window)
Haryana	Application Form Availing Death Certificate (5 KB) (PDF file that opens in a new window) Application Form for Availing Birth Certificate (5 KB) (PDF file that opens in a new window)
Jharkhand	Application-cum-Declaration as to Physical Fitness (1.1 MB) (PDF file that opens in a new window)
Jammu and Kashmir	Application Form to issue Rice and Flour Mills Licence (19 KB) (PDF file that opens in a new window) Family Health Register Form (14 KB) (PDF file that opens in a new window) Form of Tribe Certificate (12 KB) (PDF file that opens in a new window) Application form for Registration of Dental Clinics/ Establishments (21 KB) (PDF file that opens in a new window) Application Form for Registration of Dental Laboratory (21 KB) (PDF file that opens in a new window) Application Form for Registration of Dental X-Ray Unit (22 KB) (PDF file that opens in a new window) Application Form for Medicines Consultants under the J&K State Health Plan (31 KB) (PDF file that opens in a new window) Application Form for Recognition of Private Hospitals,Nursing Homes, Clinics and Pathological Laboratories for Treatment of J&K State Employees (21 KB) (PDF file that opens in a new window) Certificate of Approval to Blood Storage Centre for Storage of Whole Human Blood and/or its Components (20 KB) (PDF file that opens in a new window) Application Form for Registration as a Dentist (22 KB) (PDF file that opens in a new window) Application Form For Contractual Appointment Under State Health Society (32 KB) (PDF file that opens in a new window) Blood Donor Questionnaire And Consent Form (71 KB) (PDF file that opens in a new window) Application Form for Contractual Appointment of Doctors under National Rural Health Mission (75 KB) (PDF file that opens in a new window) Medical Fitness Certificate (13 KB) (PDF file that opens in a new window) Fitness Certificate Issued to Animals (12 KB) (PDF file that opens in a new window) Application Form for Journalist Health Card (19 KB) (PDF file that opens in a new window) Application for Inspection of Private Hospitals, Nursing Homes and Pathological Laboratories (22 KB) (PDF file that opens in a new window) Check List for Inspection Team for Accreditation of Private/NGO Hospitals (19 KB) (PDF file that opens in a new window) Application for Recognition of Hospitals for Treatment of State Government Employees (24 KB) (PDF file that opens in a new window) Application Form for Reciprocal Registration of Medical Professionals with Medical Council (20 KB) (PDF file that opens in a new window) Application Form for Obtaining a Good Standing Certificate from Medical Council (18 KB) (PDF file that opens in a new window) Form for Registering Additional Medical Qualifications with Medical Council (23 KB) (PDF file that opens in a new window) Application for Sterilization Operation and Consent Form (21 KB) (PDF file that opens in a new window) Grant or Renewal of a License for the Operation of Blood Banks (25 KB) (PDF file that opens in a new window) Registration Form of National Conference on Evidence Based Health Care (138 KB) (PDF file that opens in a new window) Form for Admission into the Hospital for Medical Treatment (20 KB) (PDF file that opens in a new window) Medical Certificate of Cause of Death for Non-Institutional Deaths (32 KB) (PDF file that opens in a new window) Application Format for Vacancies at District Health Society Jammu (50 KB) (PDF file that opens in a new window) Application Form for Contractual Appointment under State Health Society (16 KB) (PDF file that opens in a new window) Application of Health Certificate issued to Animals (14 KB) (PDF file that opens in a new window)
Lakshadweep	Birth Certificate (Malayalam) (24 KB) (PDF file that opens in a new window) Birth Certificate (English) (27 KB) (PDF file that opens in a new window) Death Certificate (English) (26 KB) (PDF file that opens in a new window)
Maharashtra	Application Form for Complaints regarding Medical Health: Ulhasnagar (167 KB) (PDF file that opens in a new window) Application Form for Complaints regarding Public Health: Ulhasnagar (219 KB) (PDF file that opens in a new window)
Meghalaya	Proforma for Birth Report (15 KB) (PDF file that opens in a new window) Form for Filing Returns by Bulk Consumers under Batteries Rules (External website that opens in a new window) Application of Authorisation under BMW Rules (External website that opens in a new window) Form for Annual Report under BMW Rules (External website that opens in a new window) Form for Application of Authorisation under Hazardous Waste Rules (External website that opens in a new window) Form for Filing Returns Regarding Handling of Hazardous waste (External website that opens in a new window) Form for Reporting an Accident (External website that opens in a new window) Form for Application of Authorisation under MSW Rules (External website that opens in a new window) Form for Application of Registration under Plastics Rules (External website that opens in a new window) Form for Filing Water Cess Returns (External website that opens in a new window) Form for Availing Pollution Clearance (External website that opens in a new window) Application for Consent for Discharge (99 KB) (PDF file that opens in a new window) Format for Submitting Annual Report to Municipal Authority (74 KB) (PDF file that opens in a new window) Form for Accident Reporting under MSW Rules (45 KB) (PDF file that opens in a new window) Application Form for Consent for Emission/Continuation of Emission under Section 21 of the Air Act (73 KB) (PDF file that opens in a new window)
Manipur	Performa for Birth Report (34 KB) (PDF file that opens in a new window) Performa for Death Report (31 KB) (PDF file that opens in a new window) Performa for Still Birth Report (External website that opens in a new window) Application Form for Registration of Private Hospital, Nursing Homes and Clinics (External website that opens in a new window) Application for Grant of Renewal or Restricted License to Sell Drugs (External website that opens in a new window) Medical Certificate of Cause of Death for Non-institutional Deaths (External website that opens in a new window) Application Form for Obtaining Birth Report (769 KB) (PDF file that opens in a new window)
Madhya Pradesh	Application for Recognition of Hospitals for Treatment of State Government Employees (External website that opens in a new window) Application for Inspection of Private Hospitals, Nursing Homes and Pathological Laboratories (External website that opens in a new window) Claim Form for Vijayaraje Janani Kalyan Bima Yojna (83 KB) (PDF file that opens in a new window) Application for Permission to Appear in Examination of Promotional Training for Female Health Worker (External website that opens in a new window) Certificate of Health for Overseas Scholarship (Hindi - Download Kruti Dev 010 Fonts) - External website that opens in a new window Health License Renewal Form (Urban Administration & Development) (Hindi - Download Kruti Dev 010 Fonts) - External website that opens in a new window Application Form for Deendayal Antyodaya Upchar Yojna (22 KB) (PDF file that opens in a new window) Application Form for District / State sickness assistance fund (31 KB) (PDF file that opens in a new window) Referal Slip for Janani Suraksha Yojna (15 KB) (PDF file that opens in a new window) Application form for State Illness Assistance Fund (45 KB) (PDF file that opens in a new window)
Mizoram	Application Form for Registration of Birth - in Mizo (17 KB) (PDF file that opens in a new window) State Illness Assistance Fund (SIAF) (8 KB) (PDF file that opens in a new window) Request for assistance in state illness assistance fund (622 KB) (PDF file that opens in a new window)
Odisha	Application for Water Supply/Sewerage Connection (18 KB) (PDF file that opens in a new window) Application-cum-Declaration for Physical Fitness (9 KB) (PDF file that opens in a new window) Application Form for JTS Disabled Person Identification Card Issuance (904 KB) (PDF file that opens in a new window) Application Form for Medical Certificate (807 KB) (PDF file that opens in a new window) Application for Grant /Maintenance/Renewal of Certificate of Registration of Clinical Establishment (549 KB) (PDF file that opens in a new window)
Punjab	Application Form for Obtaining the Post-Birth Benefit of Rs. 500/- (for urban areas) (79 KB) (PDF file that opens in a new window) Health Certificate Issued in regard of Animals (12 KB) (PDF file that opens in a new window)
Puducherry	Health Register (62 KB) (PDF file that opens in a new window) Grant or Renewal of Drugs License (40 KB) (PDF file that opens in a new window) Grant or renewal of a restricted drugs licence by retail dealers who do not engage the service of a qualified person (43 KB) (PDF file that opens in a new window) Grant or Renewal of Drugs License - Motor Vehicle (48 KB) (PDF file that opens in a new window) Licence to Sell, Stock or Exhibit for Sale, or Distribute Homoeopathic Medicines (44 KB) (PDF file that opens in a new window) Grant or Renewal of Licence to Manufacture Drugs Other Than Specified Drugs (45 KB) (PDF file that opens in a new window) Grant or Renewal of a Loan Licence for Drugs other than Specified Drugs (15 KB) (PDF file that opens in a new window) Grant or Renewal of License to Repack Drugs other than Specified Drugs (13 KB) (PDF file that opens in a new window) Grant or Renewal of Drugs Licence to Manufacture Homoeopathic Medicines or Potentised Preparations from Back Potencies Preparation (14 KB) (PDF file that opens in a new window) Grant or Renewal of Loan Licence to Manufacture for Sale Ayurvedic (including Siddha) or Unani Drugs (43 KB) (PDF file that opens in a new window) Grant or Renewal of Licence to Manufacture for Sale Drugs Specified in Schedules C and C(1)8 (44 KB) (PDF file that opens in a new window) Grant or Renewal of a Loan Licence to Manufacture Drugs Specified in Schedules C and C(1) 8b (160 KB) (PDF file that opens in a new window) Grant or Renewal of Drugs License for Large Volume Parenterals/Sera and Vaccines (13 KB) (PDF file that opens in a new window) Application for Grant or Renewal of a Loan License to Manufacture Cosmetics for Sale 17a[or for distribution] (12 KB) (PDF file that opens in a new window) Application Form For Health Care Business Association (49 KB) (PDF file that opens in a new window) Form for Issue of Individual Plastic Cards to each Central Governmet Health Scheme Beneficiaries (43 KB) (PDF file that opens in a new window) Grant or Renewal of Licence for the Operation of Blood Bank (47 KB) (PDF file that opens in a new window) Grant or Renewal of a Licence to Manufacture Cosmetics for Sale (16 KB) (PDF file that opens in a new window) Health Department Direct Recruitment For Group C Technical Posts (149 KB) (PDF file that opens in a new window)
Rajasthan	Fitness Certificate for Animals (11 KB) (PDF file that opens in a new window) Disability Certificate Application Form (45 KB) (PDF file that opens in a new window) Soundness Certificate for Animals (12 KB) (PDF file that opens in a new window) Injury Report for Animals (12 KB) (PDF file that opens in a new window) Surgical Risk Form for Animals (10 KB) (PDF file that opens in a new window) Serology Report for Animals (12 KB) (PDF file that opens in a new window) Bacteriological Examination and Antibiotic Sensitivity Report for Animals (12 KB) (PDF file that opens in a new window) Submission of Materials for Histopathological Examination (11 KB) (PDF file that opens in a new window) Animal Breeding Card (22 KB) (PDF file that opens in a new window) Blood Examination Report (21 KB) (PDF file that opens in a new window) Application Form of Fitness Certificate for Animals (27 KB) (PDF file that opens in a new window)
Sikkim	Form for Obtaining Birth Certificate (35 KB) (PDF file that opens in a new window) Form for Obtaining Death Certificate (18 KB) (PDF file that opens in a new window)
Tamil Nadu	Application for Renewal of Certificate of Fitness (8 KB) (PDF file that opens in a new window) Claim Form For Pocket Money To Ex-Servicemen Suffering From Tuberculosis, Leprosy or Cancer (4 KB) (PDF file that opens in a new window) Application Under New Health Insurance Scheme (83 KB) (PDF file that opens in a new window) Application For Grant Towards Major Surgeries (15 KB) (PDF file that opens in a new window)
Tripura	Application for Grant/Renewal of Licence for Sale of Drugs by Retail or Wholesale (48 KB) (PDF file that opens in a new window) Application for Renewal of Licences for Retail/Wholesale of Drugs (HOMOEOPATHIC) Medicines (35 KB) (PDF file that opens in a new window) The Factories & Boilers Organisation's Form-XXIX (142 KB) (PDF file that opens in a new window)
Uttarakhand	Application cum Declaration of Medical Fitness (38 KB) (PDF file that opens in a new window)
Uttar Pradesh	Application Form for Death Certificate (14 KB) (PDF file that opens in a new window)

Source: National Portal Content Management Team, Reviewed on:12-09-2011

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