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Application Form

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DR BALABHAI NANAVATI HOSPITAL

APPOINTMENT FOR CLASS I MEDICAL EXAMINATION


Date: 30 JUNE 2013
To Manager - OPD Dr Balabhai Nanavati Hospital !"!#oa$% "ile & Parle '() M*+bai -,00 0-. Dear ir / Ma$a+% 0in$l1 oblige +e b1 giving +e$i2al appoint+ent at 1o*r 2entre as per parti2*lars +entione$ belo3!

License / File No
1-4.2/2012-52

Name of Candidate
D60 H7 6N8H

Date of Bi t! / A"e
. 7U8U T 144, 19 :E7#

Date # Place of last Medical


- JU5: 2012 D#! 0 PU#6 7NDHE#6"E# O"7

Re$%ested Date
20-2- JU5:

7$$ress; B/00.%P#7T6M7 B5D8% (787T7M <OMP5E=% JE 75 P7#0% BH7:7ND7# E7 T% TH7NE ,0110<onta2t No! 1) 4914,4-.39 2) 41.>>2.343 E+ail; $i?shasingh.@1ahoo!2o+ 7ppoint+ents a22or$e$ on ;

Signature of the Candidate DIKSHA

Enclos% es:

1) 7ppoint+ent Aor+ $*l1 Bille$ in $*pli2ates! 2) elB-sta+pe$ envelope along 3ith the appoint+ent Bor+!

Tel No: 022 -2.1922.3 / ., / .-! &e'site: 333!nanavatihospital!org

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