Healthcare Initiative

Beneficiary Health Card Application

AASA FOUNDATION Healthcare Initiative

Official Beneficiary Health Card

1. Select Your Card Type

Individual Card

For single applicant coverage & medical camps

Self Only

Student Card

Subsidized card for school & college students

Student

Family Card

Covers primary cardholder + family dependents

Full Family

2. Primary Cardholder Information

Full Name (As per Aadhar / Govt ID) *

Father's / Husband's Name

Gender *

Date of Birth

Age (Years)

Blood Group

Mobile Number *

Email Address

Aadhar / Voter ID Number

Residential Address *

City

District

Pincode

3. Photo & Document Uploads

Applicant Photo

Clear passport photo for digital card

Aadhar / ID (Front)

JPG / PNG / PDF (Max 5MB)

Aadhar / ID (Back)

Optional secondary proof

5. Emergency Contacts & Medical Info

Emergency Contact Name

Emergency Phone

Preferred Hospital

Known Health Conditions / Allergies (Optional)

Beneficiary Declaration: I hereby declare that the details and documents provided are true and accurate. I understand that the official Health Card will be generated and issued upon verification by the administrative team of AASA FOUNDATION.

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