Form-'A' Application Form for registration of Homestay Establishment 1. Name of the establishment:- ... 2. Category for which applied (Silver/Gold): .. Name of the person authorized to manage the establishment . Complete postal address of the establishment: . Distance of the Establishment in kms. From : a) Airport: ..... b) Railway Station ©) City Centre: . 4) Nearestmain shopping Centre :. a e) Nearestbus stand /scheduled city bus stop: ....... . Details ofestablishment:- a) Whether owned or leased premises (enclosed proof of ownership or leased deed in case of lessee) b) Whether Building Use Permission is duly approved from the local authority on or before 31st March, 2014:- Yes/No Width of the road on which establishment is located. Details of parking area available in the establishment orits vicinity Plotarea (sqr. Mtrs) Covered Area (sqr. Mtrs) ‘No. ofRooms in the establishment (Single bed & size of each Room) (oublebed &size ofeach Room) ‘Number of Rooms (attached with bathrooms and W.C.) offered for use under the scheme Common area; (give details, in sqr. Mtrs.) (i) Lobby/Lounge .. (i) Dining space i) Additional facilities, ifany; k) Eco-friendly facilities; 1). Firefighting equipment/hydrants, ifany 7. Types of food to be provided,-8. Tariff forrooms:- (a) Singlebedroom .. (b) Doublebedroom......... 9. Details of fee to be deposited Banker’s cheque or D.D. No. & date 10, Details of enclosures supplied with the application .... 1. Particulars of owner or authorized person residing in the establishment giving age, profession, family members with their relationship and brief note on the back ground of owner or Tepresentative. (Attach check list of facilities available in the establishment as per Schedule ‘A’)SCHEDULE A Check list for approval of registration or renewal of the Homestay Establishment. Subject / facility Silver establishment Gold establishment Certification by the establishment regarding the facilities Yes/No Observation of the classification committee Building Use Permission for residential houses on and before 31st March, 2014 Well maintained and well equipped house with quality carpets/Area rugs/Tiles or Marble Flooring, Furniture, Fitting etc. in Keeping with traditional life style. Sufficient parking with adequate road width, Guest Rooms: Minimum one lettable room and maximum 6 rooms (12 Bed). All Rooms should be clean , airy, pest free, without dampness & with outside window or ventilation ‘Minimum Floor Area sq. ft. for each room Comfortable bed with good quality linen & bedding preferably of Indian design Attached private bathrooms with every rooms along with toiletries Minimum Size of each bathroom in Sq. ft. W.C. Toilet to have a seat & lid toilet paperog Subject / facility Silver establishment Gold establishment. Certification by the establishment regarding the facilities Yes/No Observation of the classification committee 24 hours running hot water & cold water with proper sewerage connections Water saving taps and showers Well maintained smoke free, clean, hygienic, pest free kitchen Dining areaD Good quality cutlery and crockery Air-conditioning and heating depending on climatic conditions with room temperature Iron with iron board on request Internet connection 15 amp earthed power socket in the guest room Telephone with extension facility in the room Wardrobe with at least 4 clothes hangers in the guest room. Shelves or drawers in the guest room. ‘Complimentary aqua guard or RO of mineral water Good quality chairs, working tables and other necessary furniture ‘Washing Machines and drycleaners in the house withOne Silver establishment Gold establishment Certification by the establishment regarding the facilities Yes/No Observation of the classification committee arrangement for laundry and dry cleaning services. Refrigerator in the room A lounge or seating arrangement in the lobby area Heating and cooling to be provided in enclosed public area. Garbage disposal facilities as per Municipal laws ‘Acceptance of cash or banker’s cheque or D.D. ‘Name , address and telephone number of doctors (to be deployed.) Left luggage facilities ‘Assistance with luggage on request Safe keeping facilities in the room Smoke and heat detector in the establishment. Security guard facilities Maintenance of register for guest check-in and checkout records, including passport details in case of foreign tourist/ in case of application for renewal. * “MP stands for mandatory * “D’ stands for desirable Note : The grading in the various categories will depend on the quality of accommodation, facilities and services created or provided. The same can be relaxed as also by the committee based on local requirement.Form —‘B’ Police verification This is to certify that Mr. / Miss / Mrs .... .... Son / wife / daughter of . residing at Since... : : ‘And applying for registration of Homestay Establishment under the Homestay Establishment Scheme, bears a good reputation and there is no adverse remarks and entries made against him or her or any members of the family at this Police Station. Signature of Police Inspector of concerned Police StationForm — ‘C’ Certificate of Registration It is certified that house ... ne Owned by Mr/ Miss/ Mrs. .... is registered for (number of rooms) for Gold or Silver category under Homestay Establishment Scheme. This certificate is issued on . And shall remain valid till .... Managing Director Tourism Corporation of Gujarat Limited Date .... Place «....0000000:Form- ‘D’ Application for Renewal of Registration of Homestay Establishment Scheme To, General Manager Tourism Corporation of Gujarat Limited. Udhyog Bhavan,GH-4, Gandhinagar. Sir, T hereby apply for renewal of certificate of Registration of this Scheme. Brief details areas under. 1. Name of the establishment.-(with complete address) 2. Date of registration with date of validity. (enclose copy of certificate of registration) As the period of validity of the registration certificate is expiring on : as so I request that the said certificate may be renewed for a further period of two years on the term and conditions as laid down under this Scheme. [check list of the approved existing accommodation and facilitation is enclosed as per schedule of the said scheme]. Tenclose herewith Banker’s Cheque or Demand Draft No. .. Dt. esses FOPRS. payable to ‘ Tourism Corporation of Gujarat Limited’ asrenewal fee. Signature of owner of establishmentFormat for undertaking To, General Manager Tourism Corporation of Gujarat Limited. Udhyog Bhavan,GH-4, Gandhinagar, Thaveread and understood all the terms and conditions mentioned in the guidelines with respect to the approval and registration or renewal of the Homestay Establishment and hereby agree to abide by me. The information and documents provided are correct and authentic to the best ofmy knowledge. ‘Name and signature of owner of the Establishment.aoe I arate i . son or wife or daughter of Me /Miss/Mrs.......sssssseeeeee . do hereby verify that the information provided above is true to the best of my knowledge and the documents are authentic. Signature of the owner of establishment