Department of Tourism, Government of Kerala

APPLICATION PROFORMA FOR  CLASSIFICATION OF AYURVEDA CENTRES

 

1.   Name of the Ayurveda Centre :
2.   Name of promoters with full postal address
      (with Telephone/Fax/E-mail address)		 :

3.   Status of owners/promoters whether Company
      (if yes, copy of memorandum &Article of Association may be furnished)

a.    Partnership firm
  (if yes, copy of partnership deed certificate of registration under the Partnership Act
   may be furnished)

b.    Proprietary concern
        (if yes, give name and address of the promoters)

 :
4.   Location of the centre along with full address    :

5.   Details of site

a. Area  
b. Title
  
c. Whether outright purchase:  Yes       No
d. (if yes, copy of the registered sale deed should be furnished) Yes       No
e. Or on lease                                                       
(if yes, copy of the registered lease deed should be furnished)		  
f. Survey Number  
g. Village, Taluk and District    
h. Distance from nearest town   
i. Distance from nearest railway station    
j. Distance from nearest airport  
:
6.   Is the centre attached to a hotel/resort/hospital   :

7.   Details of the building

  1. Plinth Area (floorwise)
  2. Building Number 
  3. Details of building license from local body
    (Attach blue print of the building and copy of building license)
 :

8.   Details of facilities                      

                  Room type                       Nos.                                 Size

     
    a.   Health room
    b.   Attached toilet
    c.   Consultation room
    d.   Resting room
    e.   Hall for yoga/meditation
    f.    Number of guest rooms
          (if attached to hotels/resorts)
    g.   Medicine room
    h.   Bath tubs attached to toilets
    i.   Other facilities (please specify. Attach separate sheet if necessary)
:

9.   Details of equipments                 

a.   Massage table (number and size)   :  
b.   Gas or electric stove  : Yes/No
c.   Medicated hot water facility : Yes/No
d.   Facilities for sterilisation  : Yes/No
e.   Facility for steam bath : Yes/No
f.    Others if any (please specify) :  

 

:

10.  Details of technical personnel

  1. Name and address of Consultant Physician     
  2. Qualification of Consultant Physician
    3. (Attach copy of the relevant certificates)
  3. Number of male masseurs             
  4. Number of female masseurs       
 :

11.   Quality of Medicine and health programme

a.   The firm supply medicines (will full address)

b.   The health programmes offered
(Specify length of each treatment programme)

 
:

12. Acceptance of the regulatory conditions
     (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 – 33, to be enclosed with the application)

 :

 

Place:                                                        

Date:                                             

 

                       Signature

Full Name & designation of the applicant