Download Application Proforma for Classification of Ayurveda Centres

APPLICATION PROFORMA FOR THE CLASSIFICATION OF AYURVEDA CENTRES 1. Name of the Ayurveda Centre, if any : 2. Name of promoters with full postal address : 3. Status of owners/promoters, whether company Is (copy of Memorandum and Articles of Association may be furnished) (a) Partnership firm (if yes, copy of Partnership Deed and certificate of registration under Partnership Act may be furnished) : (b) Proprietory concern (if yes, give name and And address of the promoters) : 4. Location of the center along with full address : 5. Details of Location (a) Area : (b) Title (whether outright purchase) If yes, Copy of the registered lease deed should Be furnished : Yes / No © Survey number : (d) Village, taluk and district : (e) Distance from nearest town : (f) Distance from nearest railway station : (g) Distance from nearest airport : 6. If center is attached to a hotel/resort/hospital : 7. Details of the building : (a) (b) Plinth area (floor-wise) Building number : : © Details of building license from local body (attach blueprint of the building and copy of building license) : 8. Details of facilities Room type : Nos. Size (a) Health room : (b) Attached toilet : © Consultation room : (d) Rest Room : (e) Hall for yoga/meditation : (f) Number of guest rooms (if attached to hotel/resort) : (g) Medicine room : (h) Bath tubs attached to toilets : (i) Other facilities (Please specify. Attach Separate sheet if necessary) : 9. Details of eqipment (a) Massage table (number and size) (b) gas or electric Stove :: : Yes No © Medicated water facility (d) Facilities for sterilization (e) facilitiy for steam bath (f) Others, if any (please specify) : : : : Yes Yes Yes No No No 10. Details of personnel (a) Name and address of consultant physician : (b) Qualification of consultant physician (attach copy of the relevant certificates) : © Number of male masseurs : (d) Number of female masseurs : 11. Quality of medicine and health programmes (a) The firm that supplies medicines (with full address) : (b) The health programmes offered (Specify length of each treatment programme) : 12. Acceptance of the regulatory condition (this should Be furnished in the prescribed proforma) : 13. Application fee (details of DD) (a demand draft for Rs.2,500/- drawn in favour of the Director, Department of Tourism, Government of Kerala Park view, Thiruvananthapuram 695 033, is to Be enclosed with the application) : Full name & designation of the applicant : Place: Date: PROFORMA OF ACCEPTANCE OF REGULATORY CONDITIONS The Director Department of Tourism Government of Kerala Park View Thiruvananthapuram - 695 033 Dear Sir, Subject : Acceptance of Regulatory conditions I have received a copy of the Regulatory conditions prescribed by the Department of Tourism for the classification of Ayurveda centers, and wish to confirm that I shall abide by the same and such other conditions as may be laid down from time to time by the Department of Tourism for the classification of Ayurveda Centres. Yours faithfully, Signature Name in block letter : Managing Director/Partner/Proprietor Name of Ayurveda center : Date: Place: