EHS Family Member Activation Deactivation, Declaration Forms

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AHCT / EHS / 2016 . Dt . 04 . 07 . 2016


Sub :

    Submission of proposal for deployment of self declaration form in EHS Portal - Reques - Reg .

      It is observed that various grievances are bring received by the Employee Health Scheme wing through complaint box , mails and grievance cell regarding deactivation of Health Cards for employees , Pensioners and their dependants under EHS . Further it is to submit that , so far there is no prescribed proforma for deactivation of dependents health cards . In this regards it is proposed that prescribed welf declaration for may be obtained from the employees , Pensioners and their dependants for further processing of deactivation

The following declaration forms are prepared : -

- 1 Declaration by the Employee for Beneficiary Deactivation
- 2 . Declaration by the Pensioner For Beneficiary Deactivation

Submitted for approval , if approved , CR will be raised to PMU Dept for deployment of self declaration profomas in the EHS - TS portal . Submitted for orders


Declaration form for Employees

Declaration form for DDO