:: AURANGABAD MUNICIPAL CORPORATION |Certificates

"Form B" (See rule 4 and 6) Application for Nursing Home Registration under section 5 of the Bombay Nursing homes Registration Act,1949

Title of Applicant * Title of Applicant *

First Name *

Middle Name

Last Name *

Email * Email *

Plot/ Flat No

Name of the Building

Name of the street *

City Name *

Pin Code *

Nearby landmark *

Address *

Mobile No *

Technical Qualification if any, of the applicant. *

Application form details

Nationality of the applicant *

Situation of the registered of principal office of the company, Society, Association or other body corporate. *

Name and other particulars of the nursing home in respect of which the registration is applied for. *

Place where the nursing home is situated & Address *

Brief description of the construction size and equipment of the nursing home or any premises used in connection there with as detailed below. *

Floor Space of ward rooms provided for
patients giving number of beds. *

Arrangement made for Medical check –up and
immunization of the employees. *

Floor space for kitchen servant's room and other rooms giving details of user and area of each room. *

Details of arrangements made for sanitary convenience for patients and employees giving their numbers. *

Details of arrangements made for storage and
service of food. *

Equipment Anabel & in use *

Whether the nursing home or any premises used in connect on their which are used or are to be used for purposes other than that of carrying on a nursing home. *

Number of beds for
maternity Patients *

Number of beds or
other patients *

Names, Ages and qualification of the member of the nursing staff in the nursing home. *

Place where the nursing
staff accommodated. *

Names, Ages and qualification of the resident or visiting physicians or surgeon in the nursing home. *

Whether the nursing homes is under the supervision of qualified medical practitioner or a qualified nurse ,and if qualifications. *

Proportion of the qualified
and unqualified nurses on the nursing staff. *

Whether the nursing home is under the supervision of a qualified nurse midwife and if so, her name age and qualifications. *

Whether any unregistered medical practitioner or
unqualified midwife is employed for nursing of patients
in the nursing home. *

Whether any person of alien nationality is
employed in the nursing home and if so, his
name and other particulars. *

Whether the applicant is interested in any other nursing home or business and, if so the place where such nursing home is situated or where such business is conducted. *

OPD *

IPD *

No.and date of expiry of the certificate of registration.

"Form A" (See rule 3) Register showing names of persons Registered under section 5 of the Bombay Nursing homes Registration Act,1949

Name of the Applicant *

Full address of the Applicant *

Nationality of the Applicant *

Name and other particulars of the nursing home in respect of which the applicant is registered *

Place where the
nursing home is situated *

Total number of patients for
whome the nursing home *

Maternity Patients*

Other Patients *

Number and date of registration *

Date of renewal of registration *

List of Documents (Attachment)

Note: Upload Below Files only pdf, .jpg, .jpeg, .bmp etc.. Max upto 5MB

Certificate of Medical Education Degree/ Diploma of Medical Practitioner and Diploma Certificate of Educational Enhancement *

Medical Practitioner's Master's Certificate registered with M.M.C. and concerned Medical Council of Maharashtra State *

Educational certificates of Nursing Cadre and updated certificates registered with Maharashtra Nursing Council *

Bio Medical waste Certificate *

Fire NOC/Form B*

Authorization Certificate of Maharashtra Pollution Control Board *

Current year property tax and water tax payment receipt of commercial rate *

Building Permission & Map/Gunthewari Certificate & Gunthewari Sanctioned Map*

Occupancy certificate and Occupancy Map *

Notarized Affidavit regarding Parking *

Registered rent agreement*

Trust Registration certificate *

Signature and Date *

* Declaration:- I Solemnly declare that above statements are true to the best of my knowledge and belief.

ONLINE CITIZEN SERVICES (RTS)

ऑनलाइन नागरिक सेवा (आर.टी.एस.)

Application for Nursing Home Registration

"Form B" (See rule 4 and 6) Application for Nursing Home Registration under section 5 of the Bombay Nursing homes Registration Act,1949

Application form details

"Form A" (See rule 3) Register showing names of persons Registered under section 5 of the Bombay Nursing homes Registration Act,1949

List of Documents (Attachment)

ONLINE CITIZEN SERVICES (RTS)

ऑनलाइन नागरिक सेवा (आर.टी.एस.)

Application for Nursing Home Registration

"Form B" (See rule 4 and 6) Application for Nursing Home Registration under section 5 of the Bombay Nursing homes Registration Act,1949

Application form details

"Form A" (See rule 3) Register showing names of persons Registered under section 5 of the Bombay Nursing homes Registration Act,1949

List of Documents (Attachment)

Upload listed files only .pdf, .jpg, .jpeg, .bmp (Max upto 5 MB)