WILLINGNESS FOR APPOINTMENT OF AUTHORISED MEDICAL ATTENDENT FOR THE PERIOD 01/01/2011 TO 31/12/2011

CGEWCC – KARNATKA

( Central Government Employees Welfare Co-ordination Committee)

OFFICE OF THE CHIEF COMMISSIONER OF INCOME TAX

C.R. BUILDING, QUEENS ROAD, BANGALORE 560 001

Tel:080-22867898   Fax: 080 - 22861655

                                                                                 Email:cgewcc.karnataka@gmail.com                 

CGEWCC(3)/CCIT/Tech-I/2010                                                                                  Dated:  26.11.2010

To,

All Heads of Office of Central Government Offices in Karnataka

Sir/Madam,

              Sub:- Empanelment of AMA’s for the period from 01.01.2011 to

                        31.12.20111 – calling for willingness – reg.

                                                 *****

             As you are aware, the term of your appointment as Authorized Medical Attendant (AMA) for the areas not covered by CGHS scheme at Bangalore, is due to expire on 31.12.2010.

             Kindly intimate whether you are willing, for the above said appointment, for the period from 01.01.2011 to 31.12.2011.  Your willingness and the declaration may please be sent in the format enclosed.  The willingness should reach the undersigned on or before 22..12.2010.

                                                                                                            Yours faithfully,

                                                                                                    ( P. CHANDRASEKHAR)   

                                                                                                          Secretary(CGEWCC)        

                                                          

To

The Secretary,

CGEWCC, Karnataka,

Office of the Chief Commissioner of Incometax

CR Building, Queen’s Road,

Bangalore 560 001

Sir/Madam,

            Sub: Option for appointment as AMA for the year 2009 – reg.

                                                            ******

            With reference to your letter No.CC-I/Tech-I/CGEWCC/151/08-09 dated 18.11.2008, I hereby offer my willingness for appointment as AMA for the calendar year 2009 in respect of the areas not covered by CGHS dispensaries.  The personal details are furnished hereunder:-

01	Name
02	Residential address with Telephone No
03	Clinic Address with Telephone No.
04	Mobile Phone No
05	Area to be covered

DECLARATION

I, Dr._____________________________________S/o. or D/o.____________________________

Residing  at No.__________________________________________________________________

do hereby declare and affirm that:-

1. I am registered with the State / Indian Medical Council under the Medical Council Act

And that my registration No. is ____________

                                                                                                                        

2. I am aware  of the Rules governing my appointment and I agree abide by the same

and any orders issued in this connection from time time.

3. I shall charge consultation and injection/charges/ fee at the prescribed rates may be

Modified from time to time.

4. I have noted that my appointment as Authorised Medical Attendant  does not confer

      any right to be confirmed as Authorized Medical Attendant and that my appointment 

      could be terminated at any time by the authority in CGEWCC without assigning

      any reasons whatsoever or without giving any notice.

Place:

Date:                                                                                      Signature with name in block letters