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PANCHGAVYA GURUKULAM

Panchgavya Study and Training Centre of Indian Celltheraphy Institute, Madurai, Tamilnadu Affiliated with 'Bharat Sevak Samaj' - Run by Government of India Postal Adress: C U Shah Bhawan, 78/79, Retherden Road, Chennai 600 007. Contact: gomaata@gmail.com, Phone : 044 26 41 47 23, Panchgavya Study & Training Centre: Vill. - Kattavakkam, Post - Teneri, Dist. Kanchipuram - 631604, Tamilnadu APPLICATION FORM FULL TIME / CORRESPONDENCE COURSE 1) MASTER DIPLOMA IN PANCHGAVYA THERAPHY 2) DIPLOMA IN PANCHGAVYA THERAPHY 3) CERTIFICATE IN PANCHGAVYA THERAPHY Photo

Name Fathers/Husbands Name Date of Birth & Age Nationality Languages Known Qualification

: : : : : : Male/Female Religion :

Experience in Alt. Medicines : Present Address Permanent Address : :

I Solemnly declare that the above facts are correct to the best of my knowledge. Date : (Signature of the Applicant) Requirements for Registration: Ten copies of your passport size photos. Four sets of Xerox copy of your Date of Birth & Educational Qualification Mark sheet and Certificates. Four Xerox copies of your Residential Address Proof.

DECLARATION
1. 2. 3. 4. Any type of travelling expenses will be bearable by the students. Lodging facilities will be Gurukul type dormitory. Fooding will be as possible as organic and vegetarian only. Non-Vegetarian Food, Packaged Food, Coldrinks and use of any type of smoking, narcotic items and liquor drinking is stricktly prohibited during course, training camp and campus area. 5. Mobile, camera, laptop and any type of other electronic devices can not be used during the course and training camp. 6. You have to deposit all your electronic devices before joining the training camp and course. 7. Any type of unfit or unhealthy person will be not eligible for this course and training camp. 8. In any case candidates cannot bring their relatives and children during course and training camp. 9. Please do not carry any type of valuable items like jewellery, electronic devices etc. with you. 10. You have to follow the Dincharya of gurukul stricktly. 11. Simple Bhartiya food will be provided to the candidates. 12. In case of any type of injury, accident or death candidate is responsible itself. Insurance and damage can not be claimed. 13. If any candidate found violating gurukul rules or doing any illigal activity like theft, teasing to female candidate etc. will be immidiately dismissed and restigated from the course and training camp. 14. Only Bhartiya ethnic wears allowed for dress code. Western cloth like jeans, skirt, short wears etc are prohibited. 15. If necessary Panchgavya Gurukul have all rights reserved to modify any rule and regulation any time. 16. In any case area of jurisdiction is Madurai only.

Signature of the Candidate Email: Date: Mobile No.:

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