Application Form for Matheran Sanatorium

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

Number of people:

First Name:*

Age:*

Gender:*

Address:*

Telephone Number:*

E-mail:*

Details of Applicant 2 (*if Applicable)

Full Name:

Age:

Gender:

Relation with Applicant 3:

Details of Applicant 1 (*if Applicable)

Full Name:

Age:

Gender:

Relation with Applicant 3:

Details of Applicant 4(*if Applicable)

Full Name:

Age:

Gender:

Relation with applicant 1:

Details of Applicant 5(*if Applicable)

Full Name:

Age:

Gender:

Relation with Applicant 1:

Proposed Dates of Stay* (Inclusive of both days in mm/dd/yyyy):

From:

To:

Recommended by (*if Applicable):

Name:

Telephone:

Email:

How did you hear of us *

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.

Submit