Lilly Garden
Application for Admission

Name of the Applicant *

Name of person to whom admission is sought *

Age & Date of birth of resident *

Relation with the Applicant *

Address *

Phone no. of the Applicant *

Phone of any other close relative with Name & Relationship *

Reason for admission (Sick / Bedridden / Old age) *

Any other reason

Details of Family members of resident

Name

Relation

Phone no.

Declaration

I, hereby agree to the terms and conditions prescribed by Lilly Garden and express my willingness to admit my Mr/Mrs with his/her consent in Lilly Garden.

Place * :
Date * :

Signature * :
Name * :

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Lilly GardenApplication for Admission

Declaration

Lilly Garden
Application for Admission