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Shantikunj Sevashram

Centre for Dignified Living for Senior Citizens

Project from Vidyadhiraj Charitable Trust ®

Rules & Regulations for Admission

w.e.f. 1st April 2010

Harigram-Kevale Junction, New Panvel-Morba Road, Panvel 410206

Tel. ( 02143)-236097 / 236101 / (022) 24118895 / 24121535


INDEX

1. Establishment. pp. 4.
2. Shantikunj Sevashram. pp. 5.
3. Management and Administration. pp. 6.
4. Objectives of Shantikunj Sevashram. pp. 7.
5. Rules and Regulations Relating to Admission. pp. 8.
a. Eligibility for Admission. pp. 8.
b. Ineligibility for Admission. pp. 9.
6. Admission Procedure. pp. 10.
7. Mode of Life. pp. 13.
8. Payment for Services. pp. 15.
9. Medical Care / Treatment. pp. 18.
10. Visitors. pp. 19.
11. Spiritual / Wellbeing. pp. 20.
12. Death and Funeral. pp. 21.
13. Amendment of Rules and Regulations. pp. 22.
14. Application of Rules and Regulations. pp.
15. Appndix. pp. 28.

1. Declaration by Applicant. pp. 29.

2. Application for Admission. pp. 30.

3. Letter of Undertaking. pp. 34.

4. Agreement. pp. 36.

5. Desirable. pp. 38.


1. Establishment:

Shantikunj Sevashram is a Charitable institution run under the auspices of the


renowned Vidyadhiraj Charitable Trust ®, Wadala, Mumbai, a non-profitable
Public Charitable organization, an NGO under the guidance of revered
Shrimad Vidyadhiraj Teerth Sripad Vader Swamiji of Gokarna Partagali
Jeevotham Math , Parthagali Goa.The Vidyadhiraj Charitable Trust ® (VCT)
is a public charitable trust founded in November 1998 for undertaking various
human welfare service activities for the benefit of the society at large. The VCT
conducts its multifarious activities through four separate foundations, which
function as its organic limbs. These limbs or units are as under

1. Sevashram Relief Foundation.

2. Jeevottam Medical Foundation.

3. Saraswathi Educational Foundation.

4. Shanti Seva Prathisthan

The Sevashram Relief Foundation has established an integrated complex at


Harigram, Near New Panvel (Dist. Raigad) known as Shantikunj Sevashram,
which has a Centre for Dignified Living for Senior Citizens.

2. Shantikunj Sevashram:

Shantikunj Sevashram is situated at Villages Harigram & Kevale , on New


Panvel - Morba Road, Taluka Panvel,Dist. Raigad. This Sevashram is about 5
to 7 kms from New Panvel, New City Township under CIDCO, Government of
Maharashtra. Nearest Railway Station is Panvel Junction, and the Nearest
State Transport Bus Depot is at Panvel situated at NH-4, Highway.Mumbai –
Pune express highway passes near New Panvel City. Proposed New Bombay
Airport is planned near Panvel. The Shantikunj Sevashram is well connected
by Autorikshaws and 10 seater larger rikshaws (locally called Tum Tum) from
State Transport Depot

From Panvel railway station there are train services to Thane (Central
Railway) and Andheri (Western Railway) , besides regular services

To Chatrapathi Shivaji Terminal). . The fare in Tum Tum for a seat is Rs from
State Transport Depot to Hrigram. Whereas single Rikshaw charges are
between Rs 60/= to Rs 80/= to Shantikunj Sevashram .

Limited State Buses operate between Panvel and Morba, via Harigram/
Kevale .
The Shantikunj Sevashram is housed near the bank of Kalundri river that flows
during monsoon and on other days remains stagnant. Also the villages Harigram and
Kevale are surrounded on three sides by hillocks.In all the Sevashram is located on
beautiful and natural with all the associated scenery. This is a far cry from the hectic
Bombay City.

The calm atmosphere of the Sevashram provides a lively environment in which the
residents of the Ashram can live a happy and blessed life with confidence and
independence.

3. Management and Administration :

The general management and administration of the Ashram is vested with an


appropriate empowered committee 9 called the Supervisory committee) of
active and dedicated individuals, under the overall guidance and supervision of
the Trustees of the VCT. The role, responsibility and the power of the
Committee will be to monitor the day-to-day administration and maintenance
of financial accounts, work out ways and means for funds mobilization, and
suggest to the Board of Trustees the necessary capital expenditure by budgetary
allocation.

4. Objectives of Shantikunj Sevashram:

The main objective of the Sevashram is to provide residential accommodation (in the
Sevashram) to persons who have retired from their profession, service or business and
who want to live independently in serene atmosphere, with dignity and reasonable
emotional security. Also to provide medical services, meditation-cum-prayer facilities,
reading room and library, yoga centre etc. in the campus of the Sevashram.

5. Rules and Regulations Relating to Admission :

1. Eligibility for Admission :

Admissions are restricted to:

•Persons and their spouse who have opted for VRS, retired from active
service / business / profession and who are not engaged in any full
time occupation are eligible to apply for Resident membership and
accommodation.

•A team of Doctors appointed by the Trust would examine persons


seeking Resident membership and accommodation, and issue
certificates for admission or otherwise and, this will be final and
binding on the Applicant.

•The applicants must be financially in a position to pay their monthly


maintenance fees / expenses as prescribed by the Trust from time to
time. The applicant must give two sureties who would guarantee on
behalf of the members..

2. INELIGIBILITY FOR ADMISSION.

Admissions are not open to people who are suffering from infections and
mental diseases, or against whom criminal cases are pending in courts for
offences or who is known to be alcohol or drug addicts.

6. Admission Procedure :

1. All persons desirous of becoming residents at the Sevashram are to


apply on the prescribed form and execute a written agreement on
stamp paper in the presence of two witnesses agreeing to abide by
the Rules and Regulations of the Shantikunj Sevashram.

2. The mode of admission will be in accordance with the assessment


reached at by the Trusties/ Committee members after having an
interview with the applicant. The decision of the Trustees/
Committee members shall be final and binding on the applicant.

3. Every applicant applying for admission to Sevashram shall be


required to be accompanied at the time of interview by a responsible
person who is none other than his near relative, failing which he
shall produce a consent letter / credentials from such near relatives
like children, brother/s, sister/s who have attained age of majority
and are competent to contract and vouch for, or letter / credentials
from the respected citizens / religious heads/institutions and such
letter / credentials shall bear the signature, full address and contact
telephone numbers for the purpose of personal interview jointly
held by the Trustees / Comitee members, with the applicant to
access his / her eligibility to admission.

4. The applicant should also furnish to the satisfaction of the Trusties


and at the time of interview the following documents in original.

i. A detailed medical report issued by a qualified


medical practitioner in accordance with the requirements of
the Institution.

ii. The name, surname, family name and full address


and contact telephone number/s mobile number/s of his/her
near relative and applicant's relationship with such person.

iii. The details of applicant's spouse including his/her


name, surname, family name, date of birth, address, contact
telephone number/s etc. if the applicant is married.

5. Every admitted applicant shall remit at the time of admission the


service charges / fees security deposit / service charges for special
nurse etc. as prescribed in the Rules and Regulations.

6. Amount, if any, standing at his / her credit / according to the


account of the Sevashram will be refunded to the inmate when he /
she leaves the institution. But such amount will not carry any
interest. Such amount/s at his / her account unclaimed for more
than one calendar year from the date of leaving will be adjusted for
the welfare of the poor Residents.

7. The of the Sevashram may refuse admission to any applicant whose


character or antecedents has not been satisfactory or for any other
reasons which the Trusties deem fit.

8. Any inmate who has obtained admission by means of false


representation of any kind or who may be found guilty of
indiscipline / misconduct shall be dismissed from the Institution.

9. No inmate will be re-admitted when once he / she is dismissed / sent


away from the Sevashram. The decision of the Trusties shall be
final and binding upon the applicant.

10. Application for admission as Resident Member and for


accommodation will have to be made in the prescribed form. Every
such application shall be recommended by a responsible person
(acceptable to the Trusties) and endorsed by relatives (close, blood
relation) of the applicant.

11. The applicant on admission shall,

i. Become a Resident Member of the Sevashram on payment of non-


refundable Admission fee of Rs. 11,000/- per person;

ii. Rs. 10,000/- Emergency Fund for Hospitalisation, etc., if any, which is
refundable.

While admitting the resident, Complete Blood Test Report and Medical
History Report need to be attached with the Admission form duly filled in
mentioning at least 3 contact addresses (specifying lane, road, landmark etc.),
with contact / mobile numbers of near and dear ones, together with 3 Passport
size photographs of the prospective resident.

12. The Trust / Management reserves the right of admission and the
Management’s decision in this regard will be final.

7. Mode of Life :

i. Comprehensive accommodation services is made available to all


Residents through out their life at the Sevashram. Applicants
have a free choice of any of the following four types of housing /
accommodations, subject to the availability of rooms.
ii. Type ‘A’ = Single Occupancy in Self-contained Room in
Residential Building.
iii. Type ‘B’ = Single Occupancy in an independent spacious Room
in independent Cottage with Verandah.
iv. Type ‘C’ = Double Occupancy in Self-contained Room in
Residential Building – for two persons of the family.
v. Type ‘D’ = Double Occupancy in independent Cottage Room –
for two persons of the family.
vi. To maintain a good family atmosphere the Residents should live
in mutual love, friendship and respect and shall use their God -
given health, and availability by voluntarily engaging in small
jobs / works for the organization and thereby support the welfare
of our society.

vii. To cultivate and develop amity and unity among themselves, the
Residents shall try to co-operate with each other and join
together for prayers, food, games, entertainment and other
activities.

viii. All Residents shall maintain strict discipline and silence at the
Sevashram and all Residents should be careful not to disturb the
other brother/sister Residents in their sleep between 9.30 PM and
6 AM.
ix. All Residents should be punctual in their routine activities at the
Sevashram including food, prayers etc.

x. Every Residents handling good/s or article/s of the Sevashram


whether big or small shall be responsible for the safe custody and
preservation in good condition of such goods / or articles as if
they belong to them.

xi. Smoking, drinking alcohol and betel - chewing, cards playing for
money within the Sevashram is strictly prohibited.

xii. Residents should not be allowed to eat at nearby restaurants and


shops.

xiii. Residents should not be allowed to make outgoing telephone calls


from the Sevashram.

xiv. The Sevashram reserves with it every right to dismiss inmate/s


who indulge in serious acts of indiscipline, objectionable behavior
and or any other act/s that disturb the peaceful atmosphere of the
Sevashram.

xv. Presently, there is no facility for bed-ridden persons and or


persons with unstable mental / physical health.

xvi. Separate Geriatrics / Gerantology unit may be introduced in


future, at present these facilities are not exist in the Sevashram.

8. Payment for Services :

The monthly payment covers the following:

1. Maintenance of room,
2. Water,
3. Electricity,
4. Food, Vegetarian Food (no eggs also allowed)

. 07-00 a.m. morning tea

09-00 a.m. breakfast

01-00 p.m. lunch

04-30 p.m. tea with light snacks or biscuits

7-30 p.m. dinner


Consumption of alcohol and/or smoking within the Complex
strictly prohibited.

5. Salary of the staff,


6. Entertainment,
7. Library,
8. Reading room and
9. Newspaper.

10 Accomodation :

Types of accommodation are as under :

i. Type ‘A’ = Single Occupancy in Self-contained


Room in Residential Building.

ii. Type ‘B’ = Single Occupancy in an independent spacious


Room in independent Cottage with Verandah).

iii. Type ‘C’ = Double Occupancy in Self-contained Room in


Residential Building – for two persons of the
family.

iv. Type ‘D’ = Rs. 5,900/- per month (Double Occupancy in


independent Cottage Room – for two persons of
the family).

There shall be three sets of charges depending upon the purpose and
duration of stay :

i. Temporaray accommodation from one month to six months.


This accommodation is provided to fresh inmates to familiarize
with the ashram surroundings and atmosphere so that the
Resident can take a decision to stay permananetly, subject to
other reules aond conditions of the Asram are met. During
thisperiod, both the Residents and Ashram authoirities ahall
faimiliarise each other. Both have a right to discontinue the
association without assigning any reason.

. Salientent terms for such an engagement are as under :

a) No Admission Fee.

b) For persons beyond 60 years of age, seeking admission, and


on trial basis, Rs. 10,000/- refundable deposit for medical emergency, if any.
c) On expiry of six month trial period, if admitted, extra amount
so paid could be adjusted.

d) .Boarding and Lodging (per day, Temporary period – shall be


as per attachment - BBBB which shall be revised at the start of every
finanacial year

ii. Permanent accommodation

Those who have completed six months of stsya may choose to


convert their status as Permanent residents subject to the
approval of the Asram Management, .Boarding and Lodging
shall be as per attachment - BBBB which shall be revised at the
start of every finanacial year.

However, Management, at it’s discretion may waive of this period


in part or full and make an applicant’s residence permanent,

iii. Daily accommodation :

9. Medical Care / Treatment :

The state of health of every Resident Member will be checked by a panel of


doctors attached to the Medical Centre at the Sevashram as and when
practicable. Members will be treated free of charge, as out-patients for any
minor ailment, by the doctors at the Medical Centre.

Trust is not liable to inform the relatives of the inmate on a regular basis their
health condition, unless the prescribed medical officer advises the authorities to
do so. Howvever, the relatibes may go through the medical records at Ashram
site. In case of any serious illness or ailment requiring treatment / surgery as
in-patient, such a Member will be shifted to the Medical Centre of
Administration’s choice, and the relatives of the Member concerned will be
informed as soon as possible. All expenses including pre-admission deposit to
be made with the Hospital will be provided by the in-patient or his/her relative
immediately on requirement, at the Medical Centre /Nursing Home/Hospital
and will have to be borne by the Member or his / her relative.

The respsonsibility of the administration ceases once the patient is admitted in


the nursing home,

10. Visitors:
a. Relatives or friends of the Resident Member will be
permitted to visit the campus only during daytime.

b. To maintain continuous contact with the Residents family


and others, visitors are allowed on all days. The Residents shall use the
visitors room for this purpose. Anyhow the ashram will not provide food
and shelter for any of the visitors. Anybody wants to stay over night,
rooms and food will be provided on payment.

c. It will be within the sole discretion of the Management


whether to allow a visitor to stay overnight in the specified
accommodation in the campus, on payment of prescribed charges.

d. Prior special permission from the authorities is required


before going out of the Sevashram. Likewise, the authorities concerned
shall be informed on return.

e. Residents who desire to visit their houses as per their


requirements or wishes shall be allowed to do so. But no inmate will be
allowed to go home unless responsible relative comes to take him / her and
agrees to bring him / her back. If necessary, one of the ashram-staff will be
allowed to accompany him / her provided the inmate concerned, meets
his / her travel expenses.
11. Spiritual / Wellbeing :

The Sevashram pays much importance to the spiritual well - being of the
Residents. Ashram has a holli temple of Sri Ram. This temple serves as
prarthana mandhir and also caters for spiritual uplifting. Residents can
do pooja and prarthana here and observe many Hindu religious functions.

12 Death and Funeral :

In the unfortunate event of death of a Resident Member, efforts will be made as


soon as possible to contact his / her relative (s) at the address available in
the office records. In case the relative fails to satisfactorily respond in a
timely manner or fails to take possession of the body within 24 hours of
the demise, the funeral rites will be performed by the Sevashram in such
manner as may be deemed appropriate. No complaint or grievance what
so ever as regards the medical treatment or alleged negligence of any sort
and/or as regards the disposal of the body will be entertained.
On the death of any inmate at the Sevashram, if the relatives desire to take the
body to their own native place, they can do so. In other cases funeral will
be done by the authorities in such manner as the authorities think fit and
proper.
The address and telephone number of the nearest relative to be intimates, in the
event of death or serious illness of the inmate should be given at the time
of admission itself.

3. Amendment of Rules and Regulations :

The Rules and Regulations of registration of Residents will be subject to the


changes effected from time to time by the Authorities in accordance with
the change in time and circumstance.

4. Application of Rules and Regulations :

Every applicant admitted as Residents of Shantikunj Sevashram shall strictly


follow the Rules and Regulations of the Bhavan.

1. Responsibilities:
a) It will be the responsibility of every Resident Member to take care of his /
her personal articles and belongings and the Management will not be
responsible for the loss of any such article or belonging. The Management
will provide, subject to availability, limited storage space / steel cupboards
for keeping the personal belongings under lock and key within the room.
b) Members and visitors should use the Sevashram accommodation and
campus (including the common facilities and amenities) with due care, to
avoid any loss, breakage or damage. In the event of occurrence of any
such loss, breakage, damage etc. due to the negligence and / or misuse by a
Member or his visitor(s), the cost of repair or replacement as determined
by the Management will be recovered from the Member concerned.
c) Plucking flowers from the plants in the complex is simply prohibited. Strict
action would be taken against any resident violating this code of conduct.
d) Each of the residents should actively participate in the common ‘Prayers’
before the lunch and dinner.
e) Each of the residents should pro-actively participate in group activities such
as Yoga, Bhajan, Pravachan, Prayers etc.

2. Rights:
A Resident Member or his/her nominee / legal heir shall not have, nor he/she
shall be deemed to have acquired, at any time, any right, title or interest
what-so-ever in the accommodation allotted to the Member, or in any part
or parcel of the common facilities and amenities provided at the
Sevashram for the use of the Member. The entire property shall be always
in the possession of the Trust and occupants have no right, title or interest
in the premises other than to live in the room allotted to them from time to
time. Trust is authorized to change the allotment of the room at any time
at their sole discretion and the same shall bind the occupants, and no
complaint will be entertained in this respect by the Trust.
3. Maintenance Fees & Facilities:

Every Resident Member will have to pay as maintenance fees/ expenses every
month such amount in vogue as duly fixed by the Management. The
Management from time to time may revise the said amount. The Member
will have to always pay (and keep) three months’ maintenance fees/
expenses in vogue, in Advance, from time to time.
The food will consist of morning tea/coffee, breakfast, lunch, evening tea/coffee
and dinner. The food served will be strictly vegetarian.
The Management will provide bed linen and pillow covers to the residents.
Members will have to make their own arrangements for cleaning their
personal clothing and linen. Laundry services will, however, be made
available against payment, if required.

4. Conditions:
Every Resident Member will have to stay in the accommodation allotted to
him / her, which may be changed at the discretion of the Management. In
addition, he / she will be entitled to the use of common facilities and
amenities, such as the Central Library, Meditation Centre, Prayer Hall,
Garden, Yoga Centre etc. provided by the Sevashram for the welfare of
the residents in general.
It will be the responsibility of the individual Member to keep the
accommodation allotted to him/her in a neat and tidy condition. The
Management will look after only the general cleanliness / maintenance of
the residents’ rooms as well as of the campus of the Sevashram, including
the common facilities and amenities.

5. Campus Atmosphere / Code of Conduct:

• Every Resident Member will be obliged to create, foster and maintain a


healthy, clean, cheerful and congenial atmosphere in the Sevashram
campus. Any Member found misbehaving or causing nuisance to fellow
Members or creating disharmony in the campus will render
himself/herself liable to his/her membership being terminated forthwith
and summarily evicted; the decision of the Trust / Management in that
behalf will be final and binding on the Member concerned.

• Use of or bringing the narcotics, alcohol or any other intoxicating item /


substance in the campus, is strictly prohibited. Smoking is prohibited in
the campus.

• A Member wishing to go and stay out of the campus for a short duration
may do so only after recording the prescribed details in the Register kept
in the Sevashram office for the purpose.
• A Member may be permitted to stay out of the campus overnight with a
friend/ relative, on giving prior intimation and prescribed information to
the Manager, in writing. If a Member desires to go on a holiday or
vacation for a period not exceeding 30 days (at a time), he/she may do so
after securing written permission from the Management, and such
permission will normally be granted as a matter of course. However, if
he / she desires to stay out for more than 30 days, the Management will
take the decision on such a request on its individual merits and after due
enquiry. For the period of any such absence, the Member will have to
continue to pay the normal monthly maintenance fees in vogue from time
to time.

6. Notice of Termination:

A Resident Member wishing to terminate his / her membership and leave the
Sevashram will have to give three clear calendar months’ notice of such
intention and the Rule (supra) governing termination of membership shall
apply.

7. General:
Vidyadhiraj Charitable Trust ® / Shantikunj Sevashram reserves the right to
make any addition to, alteration in, or deletion from these Rules, from
time to time, as may be deemed expedient and any such modification
effected will be displayed in the Notice Board of the Trust at the office of
the Trust and is binding on the Members.
15 Apendix:

Declaration by Applicant.

Application for Admission.

Letter of Undertaking.

Agreement.

Desirable.

DECLARATION BY APPLICANT

I do here by declare that I have read and understood the Rules and Regulations
and the conditions of the eligibility for admission in the Sevashram for
which I seek admission and the Rules and Regulations of the Sevashram.
I, the applicant, fulfill the eligibility criteria and I have provided necessary
information which on being found incorrect and misleading, my admission
shall be liable for cancellation by the authority of this Bhavan at any time
without any notice to me.

Date:
1) Signature of the applicant
(Name and address)

2) Signature of the near relative


or Responsible person
(Name and address)

Referees: 1.

2.

APPLICATION FOR ADMISSION

Address of the applicant / Inmate


House name …………………………………………
Post …………………………………………………. Passport size
Village ………………………………………… Taluk
Photograph
…………………………………………
District ………………………………………… State Should be affixed
…………………………………………
Tel. No. …………………………………………….. here.
Police station Jurisdiction …………………………………………

N.B
1. Please read the following note before signing this application form.
2. Please also read the Rules and Regulations of the Sevashram before signing this
application.
3. This application form is an annexure to the agreement to be signed by the
applicant / his / her representative.
4. The entries in the application should be made by the applicant / his / her
representative in his / her own handwriting. You should sign this application in
front of Trustee of Sevashram and a witness.
5. This application and a copy of the Rules and Regulations supplied to you is an
important document. Trustee strongly recommends that the applicant seek the
advice of his/ her representative or other near relative before signing this
application, the Rules and Regulations of the Ashram and the agreement.

I. PERSONAL INFORMATION.

1. Name :
2. Surname :
3. Male / Female :
4. Age & Date of Birth :
5. Identification mark :
6. Name any of the following :
husband, wife, near relative /
representative legal guardian
with Phone No
7. Mother Tongue :
8. Other languages known :
9. Religion – Caste :
10. Occupation :
11. Dept and official address if in service :
II. FAMILY BACKGROUND.

1. Name and occupation of father :


2. Name and occupation of mother :
3. Name of spouse :
4. Occupation of spouse with :
official address
5. Name, occupation and address
and phone No .of children : 1.
2.
3.
4.
5.
6. Name, occupation and address
and phone No .of brothers and sisters: 1.
2.
7. Name and occupation of
other near relatives : 1.
2.
8. Name, occupation and address of
other benefactors in the absence
of near relatives :
9. Name and address and Telephone No.
of relative to contact in case of
emergency :

III. MEDICAL HISTORY


1. Height :
2. Weight :
3. Complexion :
4. Blood Group :
5. Health condition : Sound / weak :
6. Mental condition : Sound / weak :
7. Physical condition : Handicapped / paralyzed / others :
8. Deaf, dumb, Blind is any
to be specified :
9. Put tick mark if the applicant suffers from any of the following illness
a) Diabetes : b) Hypertension :
c) Arthritis : d) Cancer :
e) Alzheimer’s disease: f) Other serious illness :
Specify if the applicant suffers from any other disease. (e.g. addiction to liquor etc.)
10. Details of illness and the name :
and address of the doctor under
whom treatment was / is being taken.
11. Details of other serious illness if any you had :
12. Details of sugeries if you had undergone in the past :
13. Other important information :
(eg. Penciling reaction, allergy etc)
14. Details of periodical medical check ups
recommended by the doctor, if any :
IV. ANTECEDENTS.
1. Name and address of other institution
if the applicant / inmate was admitted / enrolled
earlier and the reason for leaving here. :
2. Details of complaint/s leaved
against and the charges framed
against the applicant and the findings
of the court / present position of the case :
3. Is the applicant / inmate an absconded
person or wanted criminal? :

V. FINANCIAL POSITION.
1. Yearly Income :
2. Sources of income / Asset :
3. Is the applicant an income
tax assessed :

VI. LIKES / DISLIKES AND WISHES / DESIRES.


a) Food habits : Vegetarian / Non-vegetarian.
b) Hobbies :
c) Wishes / Desires if any :
d) Burial / cremation after death :

REFERENCE:
1.
2.
LETTER OF UNDERTAKING

TO,

The Trustee,
Shantikunj Sevashram,
Harigram –Kevale Junction,
New Panvel-Morba Road,
Panvel – 410206.
Tel. ( 02143)-236097 / 236101 / (022) 24118895 / 24121535

Name and address of the applicant / inmate :

Name and address of the Introducer /


Responsible authorized person. :

Relationship of applicant with introducer :

I, authorized representative / introducer of the above named applicant / inmate


admitted here to secure him / her rest and care, do hereby state and undertake as
follows :

a) That Sri/smt ……………………………………., the applicant, who is admitted now


as inmate subject to other conditions and rules and regulations of the Vishranti
Bhavan has now suffering ………………. From
………………………………………………..
For the last ………………… / several years, and that Dr. ……………………………
Under whom the inmate has taken treatment vide his medical report dated …………..
Appended herewith, has diagnosed the disease and appraised us
of the serious consequences which such patient may suffer.

b) That the authorities of the Bhavan has also explained in clear terms of the serious
consequences of the disease including acute pain, stress, mental and
other health problems the inmate may suffer.

c) That I / we have desided to get the applicant admitted as inmate after having fully
understood his physical and mental conditions.

d) That in the event of death of the inmate at the Bhavan either myself or any other
near relative of the inmate authorized by me in writing would take back the body
for burial / cremation. If no one turns up to claim the body within 24 hours on
the receipt of the intimation of death, the authorities of the Bhavan shall have
every right to bury the body at their discretion.

e) That I irrevocably and unconditionally promise to pay Rs………………. On 30th of


every month towards the service charges, special nurses’ charges and medical
expenses if any, spend by the Bhavan for the inmate and other expenses as shown
in (Art. 8,9, and other articles of) rules and regulations etc. It is agreed that this
is in addition to the security amount of Rs. 25,000/-, which is to be paid at the
time of admission.
f) That I hearby ratify confirm and agree to ratify and confirm any decision or
commitment made by the inmate in writing in favour of Bhavan and I futher
assure that no legal heir / successor / administrator shall dispute any decision or
commitment made by the inmate infavour of the Bhavan.

Date this ……………….. day of …………………….. 200 .

Witnesses : Name and signature of the applicant………………

1). Name and signature of introducer /


Responsible person ……………………………….

2).

Trustee:
AGREEMENT

This AGREEMENT is made at Harigram in Panvel district on this


……………………… Day of ……………………….., 200 between :

ShantiKunj Sevashram addresses at, Harigram –Kevale Junction,


New Panvel-Morba Road, Panvel – 410206, Panvel Taluka, Alibaug District,
Maharashtra State (hereinafter referred to as “Sevashram” which expression
shall include its successors and assigns) of the one part ;

AND
Sri/smt ……………………………………
s/o sri/smt ………………………………... aged ………………………………
occupation, residing at ………………………………………………………….
……………………………………… Village, Taluk, …………………………
District, …………………………….. State ……………………………………
(hereinafter referred as “The Relative” which expression shall include his / her
successors or nominees and / or assigns) of the other part;

WHEREAS, the relative finds that his / her, sri / smt …………………………………….
aged …………………. Years …………………………. By
profession…………………. ……………………….. residing at village
……………………………………………….. Taluk …………………………..
District ……………………………….

State ……………………...requires care, shelter, treatment and other amenities on a


permanent basis and that he / she is not in a position to provide adequate care,
shelter, treatment, attention etc; in his / her place of residence, and WHEREAS
the Relative desires that Bhavan provides complete care, shelter, treatment etc;
to the aforesaid relative on a permanent basis in the manner hereinafter
appearing, and Bhavan has agreed / consented to provide the same;

NOW THIS AGREEMENT WITNESSETH and it is hereby mutually agreed upon by


and between the parties hereto as under:

1. Sevashram agrees to admit, take care and provide shelter, treatment and other
amenities to sri / smt …………………………………………………………….. at
ShantiKunj Sevashram addresses at, Harigram.
2. The Relative agrees to make a payment of Rs ………………… (in words ………
………………………………………………. ) to the Bhavan being rent and
expenses of shelter, care, treatment, other amenities etc.., and towards the same
has remitted the said amount to the Vishranti Bhavan by means of a Demand
Draft No. ………………………. Dated ……………………. Drawn on
……………………………………………. Bank in favour of Shantikunj
Sevashram.
3. Both parties agree to abide by the Rules and Regulations of Shantikunj Sevashram
which forms as Annexure No. 1 hereto
4. Any alteration or additions to this AGREEMENT can be done in writing by
mutual consent of the parties.
IN WITNESS WHERE OF this Agreement has been executed at Harigram Panvel on
the day and the year first above written.

ANNEXURE NO. 1 TO FROM THE PART OF THIS AGREEMENT

Rules & Regulations – 6 sheets

Name ………………. Designation ……………………………. Name


………………………….. The Relative
For Shantikunj Sevashram Seal

Witness:

1. ……………………………………..
2. ……………………………………..
Should be minimum 50 years of age (May be marginally less in some
exceptional cases) and a tee-totaller.
Should be healthy ( Mentally and Physically), self managing and
mobile. Should not be bed ridden or needing intensive care at
the time of admission.
Should be educated, pleasant mannered, host and a social mixer.
Should be willing to undergo and pass prescribed medical fitness test
as desire by the management.
Should not have any criminal record in previous history and police
records.
Admission-Eligibility-Expulsion
Right of admission would be reserved at the discretion of
management committee/ governing body of the society.
Any type of offensive behavior, commercial activity, subletting,
gambling, rowdyism, prostitution, theft, willful damage to old
age home premises or property and non payment of dues will
result in summary physical expulsion.
Any inmate may be expelled if any other three Residents give written
complaints and request for his removal. This would be finally
decided by the Managing Committee.

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