Application for Empanelment of Insurance Medical Practitioner (IMP) / Chemist (eC) /
Diagnostic Centre (eDC) Under modified IMP (mIMP) Scheme

Please read the following instructions carefully prior to completing this application:

  • • This application is a legal document. You will be acknowledging by clicking a checkbox at the end of the application certifying that the document is complete and all entries contained within this application are true to the best of your knowledge.
  • • By clicking the “I Agree” button you represent and warrant that: (a) you have read, understood the terms and conditions and agree to be bound by this Agreement; (b) if you are an individual, you are of legal age to form a binding contract, or if you are registering on behalf of an entity, that you are authorized to enter into, and bind the entity to, this Agreement.
  • • Certificates and other documents are to be uploaded along with recent passport sized colour photograph. The copies of the document must be self attested.
  • • You can apply for rendering one type of service category only, e.g. If you are applying for IMP, you can not apply for Chemist and Diagnostic Centre.
  • • When a specific Area/Location is not mentioned at the time of Tender publication, it will applicable to the whole district.