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KEM HMI - Application Form

Application Form for CCHA


• Certificate of passing all previous examinations.

• Caste certificate(s), if any.

Steps to be followed :

1. Fill the form below.

2. Download the PDF file created for you and sign it.

3. Attach a passport sized picture.

4. Attach xerox copies of the documents mentioned above.

5. Attach a DD in the name of Healthcare Management Institute, K.E.M. Hospital, Pune, for Rs. 100 payable at Pune.

(Cash payments in person are also accepted. Cheque payments are not accepted.)

6. Send it by post to the following address -

K.E.M. Hospital

Healthcare Management Institute

Banoo Coyaji Building, 6th floor

KEM Hospital, Rasta Peth

Pune 411011, Maharashtra

Application Form

(* marked fields are required)

(Please do not use capslock)

Educational Qualifications