APPLICATION PROFORMA FOR THE CLASSIFICATION OF HOUSEBOATS 1. Name of the houseboat/company, if any : 2. Name of promoters with full postal address : 3. Status of owners/promoters, whether Company is (copy of Memorandum and Articles of Association may be furnished) (a) Partnership firm (copy of Partnership deed Certificates of registration under Partnership Act may be furnished) (b) Proprietary concern 4. Telephone/Fax/Email id 4. Details of houseboat Cut number : : : Canal license number and period of validity : Length : Breadth Old/new vallam Outboard engine 6. Location from where the houseboat is operated 7. Details of facilities Room type 1. Bedroom (s) 2. Toilet(s) 3. Living/dining 4. Kitchen 5. Passage (width to be given) 6. Others (please specify) 8. Number of staff 9. Details of safety equipment Number of lifebuoys Number of fire buckets Number of fire extinguishers Others, if any (Please specify) : : : HP : Nos. size : : : : : : : : : : : : 10. Facilities on board (please tick wherever applicable) a. Solid waste disposal (septic tank/chemical/directly into backwater) b. Battery operated Yes No c. Provision for electricity for light & fan on board " " d. Provision for cold and hot running water on board " " e. Provision for cold purifying water on board " " f. Refrigerator/icebox on board " " g. Arrangements for food as per the menu of Guest's choice " " 11. Acceptance of regulatory conditions 12. Details of application fee TO BE FILLED BY THOSE APPLYING FOR GREEN PALM CERTIFICATE Briefly describe 1. Solid waste & sewerage disposal system used : 2. Use of alternate source of energy : 3. Garbage disposal method : 4. Practices to avoid use of polytechene bags : 5. Practices of using recycled paper for stationery & publicity materials : 6. Practices of using local ethnic materials for construction and furniture : 7.Employment from local communities Total number of employees : Number of employees from the district Of houseboat's operation : 8. Details of certification obtained from competent authority on the performance of engine : PROFORMA OF ACCEPTANCE OF REGULATORY CONDITIONS The Director Department of Toursim Government of Kerala Park View Thiruvananthapuram-695 033 Dear Sir, Subject: Acceptance of Regulatory Conditions I have received a copy of the Regulatory Conditions prescribed by the Department of Tourism for Approval of Houseboats, and wish to confirm that I shall abide by the same and such other conditions as may be laid down from time to time by the Department of Tourism for approved houseboats. Yours faithfully, Signature Name in block letters : Managing Director/Partner/Proprietor Name of company/houseboat. Date: Place:
