Shasthaalayam

Application Form

Please Fill The Below Application Form (OR)

Download The PDF Click Here

( * Indicate To Fill Compulsary)

Name *

Age *

Father's Name *

Mother's Name *

Spouse Name *

Spouse Age *

Whether Spouse is also accompanying the applicant *

Children Details *

Religion *

Native Place (Full Address) *

Period of Living *

Present Address (place where applicant live for the last 5 years) *

Relation Details *

Annual Income (Attach The Xerox Copy of source & Supporting Docx) *

Assets if Any, In your Name *

Applicant Medical Condition (State the current diagnosed illness, if any, And The medicine Prescribed) *

Spouse Medical Condition (State the current diagnosed illness, if any, And The medicine Prescribed)

Name and Address of the Doctor or hospital regularity consulted *

References (With their full Address & Occupation & Email Id) *

Any Other Matter *

Terms and Conditions

1. Minimum age for eligibility for admission shall be 65 years and above for women and 70 years and above for men.

2. Applicants must not have any direct living children on the date of application.

3. All applicants must submit themselves to a complete medical examination person with contagious and / or terminal diseases, diseases requiring regular hospitalization, dialysis for kidney failure etc. Should disclose the same at the time of application itself.

4. All applicants must abide by and follow all rules and regulations formed by the Trust, from time to time.

5. Each accepted applicant must sign a Last Will and Testament, in a format aproved by the Trust, leaving all their belongings, after their life time, to the Trust, without any right or claim by any other person.

6. Each accepted applicant must sign an undertaking stating that, on their demise, the final rites may be performed by the trust alone as per the rites and rituals approved by the Trust.

7. Inmates shall not be allowed to leave the Shasthaalayam premises, without obtaining permission in the manner specified by the Trust.

8. Inmates may consume food / water / tea or coffee, only from the Shasthaalayam kitchen / dining room.

9. Inmates may only wear clothing provided periodically to them by the Trust.

10. Food will be served during the prescribed timings along with other inmates in the common dining hall only.

11. Entertainment timings like viewing TV Etc. will be regulated.

12. Wake up and sleeping timing will be as suggested as a practice.

13. Inmates shall abide by all instruction and regulations communicated by the trust of the Manager of Shasthaalayam entrusted with the job.

14. Inmates will be provided with medicines prescribed to them by the Medical Officers approved by the Trust for the said purpose

15. Inmates must keep all their belongings safely in the cupboard allotted to them and maintain the premises neatly at all times.

16. Inamtes must inform the caretaker/Manager immediately in case of any illness.

17. Inmates must take up day to day chores, as and when required to do so, for the benefit of Shasthaalayam.

18. Smoking and consumption of alcoholic beverages are strictly prohibited for all inmates either inside the premises of Shathaalayam or otherwise.

19. Each inmate shall treat other inmates and support staff with due respect and issues if any, between them should be reported to the Manager.

20. Inmates acknowledges and agree that they may, at any time, be evicted by the Trust for misbehaviour at its sole disretion. Each inmate will be on observation for a period of one year for their behaviour and such matters including the correctness of particulars submitted by them. The admission will be confirmed only after a period of one year of observation. During this period all the belongings of the perons will be safely stored for return in case of rejection.

21. Each applicant shall provide honest and truthful information as sought in the prescribed application form along with documents of proof, wherever specified. In case the inmates have requested intimation of their demise to any specific person's, the same will be given through the provided contract details. However the final ritual will be performed by the Trust only.

22. Visitors / relatives will be permitted to meet the inmates during visiting hours, at the visitor's lounge only with prior permission from the Shasthaalayam Manager. Admission into the rooms of the inmates is restricted.