Village- Surir,Distt.- Mathura (6th October,2017)

Attending of Camps by Patients, coming from far & near, is in itself, considered an expression of their desire/compulsion to seek free help. All patients from Camps are accepted for assistance, in good faith.

Following Eligibility Criterion have been fixed for screening the Walk-in needy beneficiaries & those referred by other Charitable OPDs:

• A person (or belonging to a family) holding a BPL Card
• A person (or belonging to a family) holding a EWS Certificate
• A Senior Citizen abandoned by his/her family
• Any exception as considered appropriate by the recommending Institution/Hospital, and the Trustees

Most poor people do not possess a BPL Card or an EWS Certificate. Hence, approval for assistance, in most cases, is based on judgment of the Hospital & Trustees.

• Hard copies of blank "Koshika Application Form for Assistance" are made available to the Hospital, where these are kept at the Reception or with the Administration Department.
• If a patient satisfies any one of the above Eligibility Criteria, he/she is requested/helped to fill up the Form.
• Before signing the Form, or affixing his/her thumb impression on it, the patient is made to understand clearly, by the hospital staff, the "Declarations" and "Terms & Conditions" contained in this Form.
• The Hospital/patient has to affix a copy of his/her photograph (both pre-op & post-op) on the Form, and for being displayed on Koshika's website.
• Trustees of Koshika Foundation approve or reject such an application, at their sole discretion.
• If the case is approved by Koshika, it reserves the right to publish/dsiplay the patients photograph on their website or in their brochures etc through print/electronic media/social media etc.
• For the approved cases, the amount agreed/estimated for the treatment/procedure is paid by Koshika directly to the Hospital, after completion of the treatment/procedure, or in stages, as may be agreed upon before-hand, between the Hospital & Koshika Foundation.
• By accepting the money from Koshika Foundation, it is understood that the Hospital has, ipso facto, confirmed that they have not and/or will not receive any financial assistance from any other source, for the same case, to the extent that such assistance is granted by Koshika. The Hospital cannot accept any financial assistance, from any other source, which is in effect, a duplication of the assistance granted by Koshika. In case of surgeries, for which Koshika pays part amount, the Hospital is free to receive assistance, for the balance, from another source; the Hospital is requested to disclose this in the "Koshika Application Form for Assistance".

Koshika conducts due-diligence of it's Partners on the basis of collation/analysis of following pertinent information (as available):

• Name, Address & Contact details (Contact person, Phone, e-mail) of the Institution
• Year of establishment of the Institution
• Type of ownership of the Institution
• Registration Number & Name of Registering Authority
• Names of Directors/Trustees/Main shareholders of the Institution
• Number & locations of satellite facilities, branches, field offices in India & outside India
• No. of Operation Theatres in Base hospital & Satellite locations
• Total No. of surgeries (of types proposed to be sponsored and Cataract, Retinal procedures, Glaucoma, Corneal transplant, Paediatric heart etc) conducted annually
• No. of fully paid surgeries conducted annually
• No. of free surgeries conducted annually
• Cost of different types of surgeries, mostly on the basis of variable costing
• Details of Doctors:
  • Number of Senior consultants (with post-graduation MD degrees or higher) on salary basis
  • Number of consultants (with MBBS degrees) on salary basis
  • Number of Doctors on visting basis & simultaneously running their private practice
• PAN No.
• TAN No.
• Bank Account details
• Latest Annual Report of the Institution
• Balance Sheet & Profit & Loss Account of last 3 years
• Total amount of donations received in a year from within India & from Overseas
• List of other Charitable bodies/NGOs/Donors rendering assistance to the Institution
• Any other documents, about the Institutions work etc