ONLINE NOMINATION FORM

The Online nomination Form

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NOMINATION FORM


(Kindly tick only ONE sub- category and Attach additional sheets / information
wherever required)

Nomination is on-going 
 



NameFull Name of Nominator
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Telephone Number:
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AWARD CATEGORIES

(Kindly tick only ONE sub- category and Attach additional sheets / information
wherever required)

A. SPECIAL AWARDS

OR

B. HEALTHCARE DELIVERY SERVICES

OR

C. BIOMEDICAL TECHNOLOGY

OR




D.PHARMACEUTICALS
DETAILS OF NOMINEE
Full Name(Individual or Organization)
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Designation
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Postal Address
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Telephone
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Mobile
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Website
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REASON(S) FOR NOMINATION: Please describe your experience, uniqueness / novelty of the facility or service provider or contribution of nominee and the reason(s) for your nomination. expce

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