(Read the instructions carefully, before filling up the Online IMAGE Application Form)

The affiliation fee for the private HCEs shall be paid upon completion of the verification process, through the payment link provided at the time of verification completion (no other mode of payments or remittance will be accepted)

Private HCIs may upload the scanned copies of following to the Online IMAGE Application Form:

1. ) Terms & Conditions of IMAGE Services , put Signature affix Office Seal on all pages (Click here for Download)
2. ) Registration Certificate of Medical/Nursing/Paramed Staff in-charge of BM Waste Segregation (self attested )
3. ) Letter of Undertaking from Segregation In-charge (Click here for Download)
4. ) Letter of Undertaking from Doctor in Charge (Hospital & Clinic) (Click here for Download)
5. ) Photo ID Card of Segregation in-charge - Self attested
6. ) PCB Licence (if the institution is already authorised by the PCB)
7. ) LSGD Licence (if the institution is already registered with ULBs/LSGDs)

(If the required documents are not uploaded; the affiliation request may get deleted from the online server and the HCI needs to re-apply again)

Govt. HCIs may upload the scanned copies of following to the Online IMAGE Application Form:

1. ) Terms & Conditions of IMAGE Services , put Signature; affix Office Seal on all pages (Click here for Download)
2. ) Proof of sanctioned bed-strength or facilities (Copy of the official document)
3. ) Letter of Undertaking from Segregation In-charge (Click here for Download)

(If the required documents are not uploaded; the affiliation request may get deleted from the online server and the HCI needs to re-apply again)

Once you click the SUBMIT button, Application Submission Form & IMAGE Terms & Conditions will be sent to your E-Mail IMAGE Affiliation process will start only after confirming the documents attached to the online application form You can track the status of application by clicking,"Request Status" in the website (https://imaimage.biz/Request-status)