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

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

1. ) Affiliation Fee(Copy of DD or Screenshot or scanned copy of Online Bank Transfer with UTR or Ref No.)
2. ) Terms & Conditions of IMAGE Services , put Signature affix Office Seal on all pages (Click here for Download)
3. ) Registration Certificate of Medical/Nursing/Paramed Staff in-charge of BM Waste Segregation (self attested )
4. ) Letter of Undertaking from Segregation In-charge (Click here for Download)
5. ) Letter of Undertaking from Doctor in Charge (Hospital & Clinic) (Click here for Download)
6. ) Photo ID Card of Segregation in-charge - Self attested
7. ) PCB Licence (if the institution is already authorised by the PCB)
8. ) LSGD Licence (if the institution is already registered with ULBs/LSGDs)

To Remit the Affiliation Fee through NEFT/RTGS, the Bank details are as

1. Account No: 0236053000038771
2. Account Name: IMAGE IMA
3. IFSC Code: SIBL0000236
4. Name of Bank: South Indian Bank
5. Name of Branch: Chackai, Thiruvananthapuram

If the Affiliation Fee is paid through Demand Draft ( drawn in favour of 'IMAGE IMA', payable at Thiruvananthapuram), the Original DD may be sent to :

The Hon. Secretary, IMAGE Administrative Office, IMA State Headquarters, Anayara, Thiruvananthapuram-695029

(If the Affiliation Fee Amount is not credited to the IMAGE and 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)