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ANNEXURE-F

STTGT *i{R frq?T frfuAg / BHARAT SANCHAR NIGAM LIMITED


(&Trf, g{fir{ EFr strctJ{) / (Govt.of Indiaundertaking)

q:r €. - FffiEF 120t2

3i-€q?IrT d :nrfl-q fu urfQgn r*


Authorisation letter for treatment in hospital

HarFrd FOqr srar t fO, frqrwqd('cT h 6ffi 4frzdfofr


rrfrTrfr hqfrzqF /gr/ gfrzaYzfuar dFfI or
drff) rrT tt
s-4 ra* 3TfufiR fr sqvr* 6-rnr 3ffiiad 6T (3r$rdrd ihT ;TEr)
f aka otr
dttrgtratra 3frCrrqilR *' grq 3T{dfud qS h 3r{sn s+ sfiR ilrr(r dT(rt
3r{dRa qt fi 3r5FR Ra a54-66 fr' fr(' ffit 1}ra;,oloa.s. filFg(-dqd 3r6ryfrdrq fi Eprqt-drq
+l slgr drc't
This is to certifu that Shri/Smt. (Name of the patient), Age is the husband /
wife / son / daughter / mother / father of ShrilSmt Desg. an employee
ofBSNL.
He/she may be admitted in (hospital name) as per his/her room entitlement i.e.
He/she may be charged as per agreed rates with BSNL, Ahmednagar..

Bills as per agreed rates may be sent to AO(Pay),O/o GM BSNlAhmednagar for payment.

B"irur ffizqrffi ft.fwrsil


Sign. of the controlling offrce authority

Tfi {F{ fi' grq / withrubber stamp

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