Nominee Details
SELF DECLARATION
I with Aadhar card/Passport number/BPL card/APL card/Driving License/OCT card/Norka Card hereby declare that details given about my
family members above is true with best of my knowledge and belief for obtaining WFHS health card to be
issued in my name and to include entitled family members list in the health card. | will be attaching all the self
attested documents copies as per requirement. If | have submitted any false documents, WFHS has right not to
issue health card to me.
I have gone through the brochure, application form & hand book & Facility chart, as soft copy
and i was fully explained about the health card and all conditions by WFHS marketing executive / WFHS staff
and i am signing the declaration only after fully understanding the contents thereof. I also understand that
empanelled hospital is fully responsible for giving treatment to me and to my beneficiaries while in hospital for
treatment.
I very well know, WFHS charitable trust responsibility is to empanelled hospitals, fix subsidized
package rates, to issue health cards to applicants, to give information about various package treatments
available in various centers through facility chart, clear card holders doubts, listen to their complaints guide
them, observe whether hospitals are following WFHS rates.
I also hereby confirm that WFHS trustee members are not liable at all as jointly and severally for
the treatment getting from WFHS empanelled hospitals for me and for my beneficiaries and if iam not satisfied
with the treatment i get from the hospital, i selected and it is my responsibility and WFHS will not be
responsible
