Star Time Media

Name of the Nominee*:

Name of the Organization:

Nomination Type* Individual Organization

Year of Establishment*:

Address for Communication*:

Official Website:

Telephone/ Telefax Number

E-Mail ID*:

Name of the Contact Person:

Designation of the Contact Person:

E-Mail ID:

Mobile No.:*

Nomination Category*:

Sub-Category:

Products/ Services/ Specialization*:

Nomination Level*

Do You Want to Nominate for Multiple Levels? Yes No

2nd Nomination Level:

Previous Awards & Achievements (if any):

Accreditations & Certifications (if any):

Annual Turnover (As per the latest Balance Sheet):

Attach Profile/ Brochure/ Prospectus:

Invitation Sent By*:

Remarks/ Comments (if any):

National Healthcare Service Excellence Awards 2024

By filling and submitting the nomination form, I declare that I have read and understood the Application & Selection process and the Terms & Conditions of the National Healthcare Service Excellence Awards 2024. I hereby agree and accept the same. I further declare that information provided in the nomination form is true to the best of my knowledge and belief.

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