ONLINE NOMINATION FORM

Online nomination Has Opened

 

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NOMINATION FORM


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

Nomination is on-going and closes on May 24th 2019.

 



NameFull Name of Nominator
Telephone Number:
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)
Designation
Postal Address
Telephone
Mobile
Website

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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