Card#	Will be Autogenerated 11 Digit
Name
Date of birth
Gender	Male
Issue Date	21 Nov 2024

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Apply Online For Health Card / स्वास्थ्य कार्ड के लिए ऑनलाइन आवेदन करें * अनिवार्य फिल्डस (Mandatory fields)
Name / नाम *
Father Name / पिता का नाम
Date of Birth / जन्म दिनांक * (dd-Mon-yyyy)	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Month 1 2 3 4 5 6 7 8 9 10 11 12 / Year 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 ( As per high school certificate in 'dd-Mon-yyyy' format. i.e. '01-Jan-1990' )
Gender / लिंग *	Male Female
Mobile / मोबाइल *
Address / पता *
Upload Photo / फोटो अपलोड करें *	( JPG,JPEG,GIF,PNG image with size upto 50 KB )
Upload Student Signature / छात्र के हस्ताक्षर अपलोड करें *	( JPG,JPEG,GIF,PNG image with size upto 50 KB )
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