Seniors Happiness Centre

Admission Form

* Terms and Conditions applicable

1) Age group : 65-75 Or 70-80 (pl choose )
2) For women only
3) Resident of India /domicile of Maharashtra
4)Widows / divorcees or anyone with no support system
5) below poverty line
6) The applicant should not be receiving any pension benefits under any social security schemes
7) Aadhar card / Voter ID card
8) no chronic diseases
9) There will be compulsory health check up required before admission
10) no criminal record

If anything is missing Pl add to thr pointers Copy of Aadhar card and 2 references Age limit should be between 65-80 Copy of ration card Capacity 30

Full Name *

Date of Birth *

Age Group

Contact Number

Address *

Health Conditions

Reason for Admission

Widows/Divorcees/Married

Emergency Contact Number

Guardian/Relative's Name (if any)

Guardian's/Relative's Number

Reference Name

Reference Number

Reference Name2

Reference Number2

Photo

Aadhar card / Voter ID card

Resident of India /domicile of Maharashtra

Ration Card