Medical, Health & Family Welfare Department, Government of Rajasthan

चिकित्सा, स्वास्थ्य एवं परिवार कल्याण विभाग Department of Medical, Health & Family Welfare

श्री भजनलाल शर्मा

माननीय मुख्यमंत्री

श्री गजेन्द्र सिंह

माननीय चि. एवं स्वा. मंत्री

माँ नेत्र वाउचर योजना
रजिस्ट्रेशन फॉर्म

District *

Block *

Facility Type *

Facility Name *

HFR

NIN Code

Registration Date *

Select Job Type *

Upload Job-related document*

Choose file...

Are you from Rajasthan? *

Yes

Aadhar/Jan aadhar no *

Beneficiary Name ( As on Aadhar Card )*

Husband’s/Father’s Name *

Father

Husband

DOB *

Age

Select Area Type *

Rural

Urban

Ward No *

Place *

District *

Block *

Aadhar Register Mobile No.*

Name of Eye Checkup Centre *

Eye Checkup Date *

Contact No (Where Eye test to be recommended) *

Medical Officer Name *

Medical Officer Designation *

Beneficiary Profile Photo *

( Size should be 3*4 cm and file size less than 2MB,File type: .jpg, .jpeg, .png )

Choose file.

Upload Beneficiary Signature *

( Size: 6 cm x 2 cm, File size: Less than 2 MB, File type: .jpg, .jpeg, .pdf )

Choose file...

Upload Prescription Photo*

( File size less than 5MB and File type: .jpg, .jpeg, .png, .pdf)

Choose file...

I hereby declare that the information provided above is true and correct to the best of my knowledge. I understand that any false information may lead to the rejection of my application.

माँ नेत्र वाउचर योजनारजिस्ट्रेशन फॉर्म

माँ नेत्र वाउचर योजना
रजिस्ट्रेशन फॉर्म