Application Home For Senior Citizens Rate Card Details Application Form Single Occupancy-20,000/-Twin sharing- 15,000/-Couple Occupancy-25,000/-3 Meals a day (veg) with coffee/tea/milkLaundry includedRegistration- 10,000/- (non-refundable)10 months advance pay.Minimum 6 months stay.Indoor gamesDormitory rooms – 10,000/-Nursing care.Facility for medical care on call (chargeable) Conatct Us Application Form Please enable JavaScript in your browser to complete this form. Data to be filled by the applicant and/or his/her relative Personal Details Name of the Inmate *Age *Marital statusMarriedUnmarriedNo. of Children, Names & their address, contact numbers and E-mail idPermanent AddressName & Address of the Guardian/ Introducer with contact NumberRelationshipFinancial ResponsibilitiesLocal contact person with details/ Emergency contact details: Health Details Chronic illness(if any)Any allergySurgery undergone with detailsOther illness requiring specific mention:Fitness Certificate by a physicianI have read all the terms & conditions and agreed the sameSubmit