APPLICATION FORM

TERMS AND CONDITIONS/ RULES AND REGULATIONS APPLY

TO BE COMPLETED IN ALL ASPECTS

Please note that filling this form alone does not mean booking formalities have been completed. Payment of Occupation Charges and Security Deposit must be received in full and unit (s) have to be allotted by our Mumbai Head Office for booking formalities to be complete.

RAO BAHADUR SHETH CURUMSEY DAMJEE AROGYA BHUVAN TRUST

APPLICATION FOR RESERVATION OF ACCOMODATION AT THE SANATORIUM IN MATHERAN

PLEASE USE CAPITAL LETTERS

* = Denotes Compulsory Field

S. Number: Online

Number of Applicants*: (NOTE only applicants mentioned on this form will be allowed to stay in the unit allotted)

Details of Main applicant*: (Applicant 1)

Full Name*:

Age*: Gender*:

Address*:

Tel. No.*:

Email ID*:

Details of any contagious disease suffered*: (if Not Applicable, state NOT APPLICABLE)

Details of Applicant 2 (*if Applicable)

Full Name:

Age: Gender:

Relation with Applicant 1:

Details of any contagious disease suffered: (if Not Applicable, state NOT APPLICABLE)

Details of Applicant 3 (*if Applicable)

Full Name:

Age: Gender:

Relation with Applicant 1:

Details of any contagious disease suffered: (if Not Applicable, state NOT APPLICABLE)

Details of Applicant 4 (*if Applicable)

Full Name:

Age: Gender:

Relation with Applicant 1:

Details of any contagious disease suffered: (if Not Applicable, state NOT APPLICABLE)

Details of Applicant 5 (*if Applicable; Minor Under the age of 10 only: refer Annexure A and Annexure B for details)

Full Name:

Age: Gender:

Relation with Applicant 1:

Details of any contagious disease suffered: (if Not Applicable, state NOT APPLICABLE)

Proposed Dates of Stay* (Inclusive of both days):

From:

To:

Date applicant last visited the sanatorium (*if Applicable):

From:

To:

Recommended by (*if Applicable):

Name:

Tel. No. :

Email ID:

How did you hear of us*:

Other:

DECLARATION AND UNDERTAKING*

I/We the applicant (s) above named, do hereby declare and confirm that the information and particulars given here in above is true and correct in all aspects. We also confirm making this application subject to what is stated in Annexure “A” and Annexure “B” hereto (Which we have duly noted) and undertake to abide by and comply with the stipulations and obligations on our part therein contained.

I agree to get the Doctors Certificate duly filled and carry the same to Matheran. Click here for the format.

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The Rao Bahadur Sheth Curumsey Damjee Arogya Bhuvan Trust is a Public Charitable Trust (Non Profit) registered with the Charity commissioner of Mumbai (Regn. No. A-2039 (BOM)).

S. Number: Online

DECLARATION AND UNDERTAKING*

Send mail to admin@matheran.org with questions or comments about this web site. +Conditions apply. Subject to Mumbai (India) jurisdiction.

Send mail to admin@matheran.org with questions or comments about this web site.
+Conditions apply. Subject to Mumbai (India) jurisdiction.