Registration Form

REGISTRATION FORM

Fee *

Accompanying person(Above 11 Yrs)

Accompanying Person(Below 11 Yrs)

Total Amount Payable *

Mobile *

Email Address *

Address *

City *

UPI NEFT

Bank Name : Union Bank of India

Branch Name : GEORGE TOWN, ALLAHABAD

A/C Holder Name : ALLD NURSING HOME PRIVATE DOCTORS WELFARE ASSOCIAT

A/C Number : 510101004320688

IFSC Code : UBIN0905330

UTR / Reference Number *

Date of Payment *(d-m-Y)

Payment Amount *

Bank and Branch name *

Transaction No *

Date of Payment *(d-m-Y)

Attach Payment Slip * (Upload only jpg/png format)

Payment Amount *

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