Employer Registration Form

Fields marked with * are mandatory

Name of Hospital / Clinic/ Organization*

State

City

District

Address

Email ID (It'll be your Login ID)*

Contact Number*

Organization Accredited By

Organization Logo

Attached Demand Aggregation

(View Aggregation Format)

HR /Medical Superintendent/Nursing Superintendent

	Name	Email Id	Mobile No
Organization HR *	Please enter HR name	Please Enter Valid Email ID Please enter HR Email ID	Please enter HR Phone Number
Nursing Superintendent *		Please Enter Valid Email ID
Medical Superintendent *		Please Enter Valid Email ID

	Organization Other Than Hospital	Hospital
SMALL	> 10 lakh rupees but < 2 crore rupees	No. of beds below 100
MEDIUM	> 2 crore rupees but < 5 crore rupees	No. of beds between 100- 350
LARGE	> 5 crore rupees	No. of beds above 350

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