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ED (Admin)Rajasthan State Minesand Minrals,Udaipur

Dear Sir,

Subject: Review proposal for empanelment with our Hospital for hospitalization and investigation

We are pleased to inform you that our hospital SHANTIRAJ HOSPITAI PVT ITD is a one ofthe leading 50bedded multi specialty hospital jn southern Rajasthan , providing all types of Surgeries ljke bariatrac,plastic sur8ery and generalsurgery, Medacine, Pediatrics, Gynae, Orthopedics, Dental, Physiotherapy,Neurology, Urology consultation with 2 fully equipped operation theater and Radiology departmentwith CT scan and diSitalX Ray, pathology investigation facilities, under one roof, with ultimate quality &results.

We are 5ubmitting this proposal for your review and consideration in empanelment with our hospital foryour attached corporate employees surgery, hospatali2ation and alltype of investigation in any modelike cashless, through TPA or cash. Please send us MOU for empanelment with us on our email or

communication address written below.

Looking forward for a long standing and mutually benef;cial relalion5hip

For any further queries kindly email us at srhudaipur@email.com ,

ThankinS You

balu.kheroda@ema;l.com

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ldontity Numbor : U851 10HJ20'12PTC038002 2011 - 2012Ertify that SHANTIBAJ HOSPITAL PBIVATE L|M|TEO is rhis day

-!t!-d under tho Companies Act, 1956 (No. 1 of 1956) and that lh6 companya;)* inited.

GwEi a! Jaipur this Twenty S€cond day ot February Two Thousand

PI,OI NO 702 ARIUN NAGAB. SECTOR 1I I]IRAN MAGBI5t*uIl - 313006.

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SHANTIRAJ HOSPITEI. PVT LTD, UDtrIPURDOGTORS PAIEL

s.No. DOCTOR'5 NAME QUATIFICATION REGD, NO, Contact No.1 Dr Ashok Jain MBBS, MS 4419 29424A10842 Dr Sapan lain M8BS, MS 89347 9a9307 44613 Dr Archana Jain MBBS, DGO (Obs & Gynae) 940664 n 514 Dr Narendra Pipliwal MBBS, D,Ch MCt 12222 94141636385 Dr lJsman Khan MBBS, MS (Ortho) RMC 007515 9199044641

Dr Gajendra Joshi MBBS, MD(Medicine), DCc 78710766177 Dr 8. S- Ranawat S.P,Th, M,I,A.P MtAP 15388 96365901558 Dr S.J. Arshi MBBS, MD (Pathology) MMC/2aO7/O21134 9602193680I Dr Ashutosh Singhi MBBS, MS (Onho) s1810/99 8829058224

Dr Shailendra Singh MBB5, Mch RMC 13131 9829040312Dr BankulGupta MBBS, DNB (Urology) RMC 941475b0a/

12 MBBS RMC 29983 941472060813 Dr 8.1. (umawat M8BS, MS (ENT) 982917955874 Dr Upavan Pandya MBBS, MD (Anesthesia) RMC 021493 916647570515 Dr. Naveen Patidar MBBS, MD (Anesthesia) 9982427 321

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HOSPITAL NAME Shantiraj Hospital Pvt LtdAD DRESS 1 699, Artun Naqar. Hiran lYaqri,Sector 11ADDRESS2CITY NAME Udarpu rSTATE NAME RajasthanPIN CODE 313002STD CODE 294PHONE NO 2481084,2481085FAX NOLANDMARK 1 Near Allahabad BankLANDMARK 2EMAIL srhudaiour@qmail conREG NOPAN NO AARCSO655DSERVICE TAX NOTAN NO

TPA CO-ORDINATOR

TONF NAI'4E North

Ms Neha BhatiI.4OBILE NO 0294 2481084BILLING PERSON .laideep TiwariMOBILE NO 9460003758ADMISSION PERSON I4s Monica RathoreMOBILE NO 0294,2481084Med cal Director Dr Sapan JainMOBILE NO 9493074467Admrnlstrator B.L. latMOBILE NO 979911.9446P!blrc Relations Hasmukh SenT4OBILE N

TOTAL AEDS 50ICU BEDS _,-1=€{0DELUXE BEDS 2 /i{a\ lI!1900-

HOSPITAL INFORMATION SHEET

Bcd Strength Detalls No. of Beds Rent per Oay

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ANNEXURE I - Format For Consultant

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EMERGENCY YesPHOTOTHERAPY

MD Physrcran

Yes

Yes 1MBBS Physicran No cMD / lvlBBS Female Physician Yes 114D Cardioloqist Yes 1MD Patholqqist Yes 1IYD Radioloqist Yes TDMLT Laboratory Technician Yes 3Nurses Yes 14OT Technrcians Yes 3x-Ray Technician Yes 2

Yes 2ECG Technician1Dietician Yes

No 0Aud ometr st2Physrotherapist Yes0Ophthalmoloqist No

Dent st Yes 2

lnsurance Client Coordrnator

Staffing avArLABlLrrY (YES / NO) NO. OF STAFF

Consultant Name Dr Sapan Jainspeciality SuroeryRegistration Number 89347OPo days and timlngs Mon- Sat, 10 am to 2 pm,5 pm to 7 pm

Private clinicAddress NATelephon€ NumbersTimings

ResidenceHiran Magri, Sector 11, Udaip!r

Telephone NumberMobile Number 9893074467Email address an drsapant@ama lccm

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SHANTIRAJ HOSPITAL PVT LTD, UDAIPUR

TARIFF LIST

OUT PATIENT DEPARTMENT

1 Hospta R€9 st.atron F@

TARIFF PER PATIENT

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2 Admss@n th.olgh Emo€ency

Ambulanc6 Facilitv Charoos

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a No emeEency Doclor s lees and €mergency charqes will be lovbd on the patie.tReq uting OPD ca.e and lhose .equ nnq admission Whe€as thos€ .ot wll ng ior lPadmissonwLllbe charged ene.gencllee ol Rs 1000( lor stay upto6 H.s. & more lhan6HB Rs 1500/ up to 24 H.s

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not avai abl€ the charges 3pp ieble io dosred catsgory ol b€d is applicab e afterconltmation trom Hosp a Adminstralor

d A I conslmables/lmplants/pham acy and investLgaton a.e chargeable

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r Operat,o. Thearor Cha,98wil b€40% of Surg@n l€€2 Pr6e@ olspecaEls\ Surgeo. sha lbe chaq€d 6n€ (To assistlheaurgeon)3 Cadoo!Lsi anendanc€ shall b€ chalgcd 6nra4 OT cooslrnabres and impanIs ro b€ b.ought frm lhe hospta & oT conslmrbles wll chargeenra 5 Emeeency Ch8rges willbe 30% betweBn 8pm lo 8 Em

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