● HEALTHCARE PROVIDER NETWORK

Hospital Onboarding.

PROTOTYPE ENVIRONMENT — USE DUMMY / TEST INFORMATION ONLY

⚡ DEVELOPMENT TEST MODE

One click fills all supported fields with fictional test data. File uploads must still be selected manually if you want to test them.

01 Hospital

02 Banking

03 Signatory

04 Contact

05 Review

STEP 01 / 05

Hospital Details

Tell us about the healthcare organisation.

Hospital Name Optional

Ownership Type Optional

Business PAN Optional

Use dummy PAN information during prototype testing.

Hospital Address Optional

Google Maps address search can be integrated later.

Pincode Optional

Hospital Category Optional

Number of Branches / Units Optional

Registered Email Optional

Registered Mobile Number Optional

OTP verification will be added later.

Account Holder Name Optional

Bank Name Optional

Account Number Optional

Confirm Account Number Optional

IFSC Code Optional

Full Name Optional

Mobile Number Optional

Email Address Optional

Government ID Type Optional

Point of Contact is the same as the Authorised Signatory
Tick this box to automatically copy the authorised signatory's name, mobile number and email address.

Point of Contact — Full Name Optional

Mobile Number Optional

Email Address Optional

Designation Optional

Designation remains independently editable even when the contact and signatory are the same person.

I confirm that this is a prototype submission using dummy/test information and that the information entered is being submitted for CurePay onboarding workflow testing. Optional during development

✓

Registration request submitted.

Your CurePay hospital registration request has been created. The identifier below is the registration request ID.

REGISTRATION REQUEST / HOSPITAL ID

This identifier will remain associated with the hospital. After successful admin verification, the same identifier will become the hospital's permanent CurePay Hospital ID.

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