3.         Status of owners/promoters whether Company 
            (copy of memorandum & Article Of Association 
            may b e furnished)

            (a)  Partnership firm (copy of partnership Deed certificate of
                  registration under The Partnership Act may be furnished)

             (b) Proprietary concern  
             
4.         Telephone/Fax/E-mail address        
5.         Detaios of House Boat                   

            Cut Number      

            Canal license number & period of validity 

            Length           

            Breadth           

            Old/New vallam     
            Out board engine            

6.          Location from where the house boat is operated   :            HP

7.         Details of facilities    

Room type            Nos.            Size

            1. Bed room

            2. Total toilets

            3. Living/Dining

            4. Kitchen

            5. Passage (width is to be given)

            6. Others (please specify)

8.            Number of staff                 

9.         Details of safety equipments   

            Number of life buoys             

            Number of fire buckets          

            Number of extinguishers :

            Others if any (Please specify)        

10.            Facilities on board (Please tick whichever is applicable)

            a)  Solid Waste Disposal (Septic tank/Chemical Toilets/Directly
  into backwater)

            b)  Battery Operated                 (Yes/No)

            c)  Provisions for electricity for light & Fan onboard 
                 (Yes/No)

            d)  Provisions for running cold and hot water onboard  
                  (Yes/No)

            e)  Provisions for purifying water onboard      (Yes/No)

            f)   Refrigerator / icebox onboard                   (Yes/No)

            g)  Arrangements for food as per the menu of Guest's 
                 choice            (Yes/No)

11.       Acceptance of regulatory conditions    

12.       Details of application fee

To be filled for applying for green palm certificate

Briefly describe,

1.         Solid waste & sewerage disposal system used ;

2.         Use of alternate source of energy

3.         Garbage disposal method:

4.         Practices to avoid polythene bags:

5.         Practices in using recycled paper for stationary & publicity
  materials:

6.         Practices in local materials used for construction and furniture:

7.         Employment for local communities

            Total number of employees       

            Number of employees from local districts         

            where the house boat operates

8.          Details of certificate obtained from competent authority on the
   performance of engine: