![]() ![]() ![]() I will also be liable for legal action by the ECHS Organisation. In addition, I will forfeit my contribution and I will pay the entire cost of expenditure incurred on such unauthorised person(s). I understand that in case I have submitted any incorrect information, or if any ECHS Membership Card is misused or used by any unauthorised person, my membership will be cancelled without any notice or further hearing. (b) That my spouse is NOT a member CGHS or any other Govt Scheme. (a) That I am NOT a member of any other medical scheme funded by Central Govt, PSU or any other Govt undertaking. I shall be liable for civil/criminal action should I fail to do so. I will refund in full, the cost of any treatment that my dependent may have received after he/she became ineligible. That in case of any change in the status of my dependants (due to death, marriage, employment), I will inform Station Headquarters, ECHS Cell at the earliest and will stop use of ECHS facilities. ![]() #Por dsc kannur plus#I shall inform the ECHS immediately of his/her/their employment of earning more than Rs 3500/- plus DA. 3500/- plus DA per month, & that my daughter(s) is/are NOT married. That my child/ children is/are dependant on me and is/are NOT earning more than Rs. (b) That is hereby certified that my parents (father/mother or both) do not draw any pension from Central Govt/State Govt/PSUs/any Private Organisation and are physically residing with me. (a) That the combined monthly income (from all sources including income accruing from house/other immovable property/fixed deposit etc) of my dependant father and /or dependent mother is less than Rs 3500/- plus DA. ![]() (Photographs(s) to be pasted and signed across by the Applicant) Signed Photo of Dependent giving name, Relationship and Identification mark That I have the following legal dependent(s) whose photograph(s) is/are affixed below on this Affidavit :. That I am/will be drawing pension vide PCDA Pension Payment Order I, _ wife/Father/Mother/Daughter/Son Service No_ Rank_ Name_ of (unit) _ solemnly affirm and declare as follows:.
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