:: 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

Applicant Title * Applicant Title *

First Name *

Middle Name

Last Name *

Plot/ Flat No *

Name of the Building *

Name of the street *

Name of the area *

Pin Code *

Nearby landmark *

Mobile No *

Email Id*

Current Address *

Application form details

Technical Qualification if any, of the applicant. *

Nationality of the applicant *

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

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

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 employee. *

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 Available &
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. *

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

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

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. *

Fees charged
to patients. *

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. *

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

Renewal From date *

Renewal To date *

"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

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 *

Biomedical waste
payment receipt (Last Month) *

Authorization Renewal
Certificate of MPCB *

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

Notarized Affidavit regarding
Parking space*

Nursing Home
Registration Certificate *

Fire NOC/Form B
(For Every Six Monthly)*

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.)

Renewal 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.)

Renewal 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)