Panchayat:Repo18/Law Manual Page0609

7. If a training centre, subjects in which training is proposed,training facilities and number of trainees proposed to be admitted: 8. Particulars of registration fees remitted

Place:

Signature of applicant:

Date :

For Office Use

1. Date of receipt of application:

2. Whether registration fees has been remitted or not:

3. Enquiry report:

4. Whether registration has been given or not (if not, state reason briefly):

5.If registered, number and date of registration:

Signature of Secretary

FORM 2

[See sub-rule (6) of Rule 3]

REGISTER RELATING TO PRIVATE HOSPITALS AND PRIVATE PARA MEDICAL INSTITUTION REGISTERED IN......................... VILLAGE PANCHAYAT

DURING THE FINANCIAL YEAR...

1. Name and address of institution:

2. Registration Number:

3. Date of registration / date of renewal of registration:

4. Name and address of person who runs:

5. Date of starting of the institution / date on which the institution was started:

6. If a hospital, number of beds:

7. (1) Number of Doctors:

(2) Number of other employees working in the institution (category wise):

8. In the case of training centres subjects in which training is given,facilities for training and number of trainees etc.:

9. Particulars regarding fees levied for registration/renewal of registration:

10. Particulars regarding annual fees levied:

11. Remarks:

12. Signature of Secretary and date:

FORM 3

[See sub-rule (7) of Rule 3]

REGISTRATION CERTIFICATE OF PRIVATE HOSPITALS AND PRIVATE PARA MEDICAL INSTITUTIONS

The....... *private hospital / private para medical institution in . ...................... Village Panchayat is *registered / has renewed registration under the Kerala Panchayat Raj (Registration of private hospitals and private para medical institutions) Rules, 1997 as No....................on the day of................... (month)................. (year). The said registration is valid upto the end of the financial year........ Address of the institution:

Name and address of the person who runs the institution:

Place:

Signature and name of Secretary

Date :

(Seal of Village Panchayat)

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* Strike out which is not applicable