Contact NO.

    in case of emergency the person to whom contact first

    in case of any undercoverege of any mediclaim

    Any Reference

    The above information as stated are true to the best of knowledge and belief

    I further declare that i shall abide by the rules and regulation of BANCHBO healing touch

    For office use only

    For ONLINE ENROLLEMENT PAYMENT, Please follow following steps:

    Open Donate Now Page > Search Donate option under AXIS BANK ACCOUNT NO – 232010100077552 > Wait few seconds to appear all projects > Search ENROLLMENT for Certified Nursing Assistant / Certified Bedside Assistant Course > Put 1 in unit option >Scroll down cursor > Click on Donate Now button > Fill up all required information > after submission you will received acknowledgement receipt in your provided email address.