Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated field as the applicant. Make sure to adhere to the format requested.
3. Select your category from the options provided. Choose 'Pensioners' or 'Others' and specify if you select the latter.
4. Provide the name of the department or service where you were last employed before retirement.
5. Indicate your last pay or basic pension amount, specifically for pensioners. Ensure it's the pre-revised rate if applicable.
6. Fill in your complete residential address. Include street address, city, state, and zip code.
7. Enter your telephone number, including your residential and mobile numbers for further communication.
8. Provide your email ID for electronic correspondence related to your application.
9. Input the date of your superannuation in the specified format (month/day/year).
10. List the details of your family members who will be included in the application. Fill in each member's name, relationship to you, and date of birth. Ensure you attach proof of age for each member listed.
11. Confirm whether all individuals listed depend on you and reside with you by selecting 'Yes' or 'No.' Attach appropriate proof of their stay with you.
12. Paste one ID card size photograph for each family member in the space provided in the form.
13. Read and agree to the declarations regarding notification of changes in dependency status and surrender of the CGHS card if eligibility ceases.
14. Attach required documents as specified, such as proof of residence, proof of age for dependents, and any necessary certificates.
15. Verify all filled information is accurate before proceeding. Lastly, save changes, download a copy for your records, print the form if necessary, and prepare to share it as instructed.

Complete your Dghs Medical Card Application Form online today!