BARAZA LA TIBA ASILI NA TIBA MBADALA (Mawasiliano yawasilishwe kwa MSAJILI)
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1 BARAZA LA TIBA ASILI NA TIBA MBADALA (Mawasiliano yawasilishwe kwa MSAJILI) Simu Ext. 331 Ofisi ya Msajili Nukushi: SLP 9083 DAR ES SALAAM FOMU NAMBA 11 TANZANIA MAOMBI YA USAJILI WA KITUO CHA TIBA ASILI (Kwa mujibu wa kifungu cha sheria ya Tiba Asili na Tiba Mbadala Na.23 ya mwaka 2002, kifungu. 35 cha kanuni za usajili) SEHEMU YA KWANZA (Ijazwe na Mwombaji) Fomu zijazwe katika nakala nne na itumike katika eneo moja tu 1. JINA KAMILI LA MWOMBAJI: Jina la Ukoo: Jina la kwanza:. Majina mengine: Utaifa Mkazi wa: Mkoa...Wilaya... Kata...Kijiji/Mtaa Tarehe ya Kuzaliwa Jinsi Anwani Simu Aina ya Kituo cha tiba asili kinachoombewa usajili (weka alama ya mbele ya aina ya kituo unachotaka kufungua). (a): [ ] Kilinge; Magonjwa ya kawaida au Magonjwa ya Akili au Kuunga Mifupa (b): [ ] Kiliniki; Magonjwa ya kawaida au Magonjwa ya Akili au Kuunga Mifupa (c): [ ] Hospitali; Magonjwa ya kawaida au Magonjwa ya Akili au Kuunga Mifupa (d): [ ] Duka la kuuza dawa za Asili au (e): [ ] Huduma za ukunga wa tiba asili 9. Anwani ya mahali Kituo kilipo...
2 10. Muda wa kuishi mahali hapo Elimu (rasmi) ya mumiliki wa kituo kinachoombewa usajili Elimu ya Uganga au Ukunga au utaalamu wa dawa: a. Muda wa mafunzo... b. Kurithi/kurithishwa Usajili wa muda/kudumu wa Mtaalamu anayeomba kusajili kituo. Mwaka aliosajiliwa.. Namba ya kusajiliwa Mwaka, Mtaalamu alipopata leseni., Namba ya leseni Aina ya tiba asili [ ] uganga, [ ] ukunga, [ ] uuzaji dawa za tiba asili 16. Aina ya huduma (weka alama panapohusika) [ ] Wagonjwa wa nje, [ ] Wagonjwa wa kulazwa, [ ] Kuuza dawa 17. Makadirio ya thamani ya dawa zilizopo dukani ni shilingi Ninathibitisha kuwa kwa jinsi ninavyofahamu maelezo yaliyotolewa hapo juu ni sahihi Saini ya mwombaji Tarehe 2
3 (i) SEHEMU YA PILI MAONI NA MAPENDEKEZO YA: OFISI YA AFISA MTENDAJI WA KIJIJI AU MTAA Wajumbe wa Baraza la Kijiji au Mtaa linalokaa kumjadili mwombaji wa fomu hii, kabla ya kumjadili muwe kwanza mnamfahamu na mnazo kumbukumbu za kumjadili yeye mwenyewe alipoomba kusajiliwa kama mganga au mkunga au muuza dawa za tiba asili. Kama hafamiki na hakuna kumbukumbu hizo mwombaji ashauriwe kuwa apeleke fomu hii katika Kijiji au Mtaa alikosajiliwa kama mganga au mkunga au muuza dawa za tiba asili. Kwa azimio lililopitishwa na Baraza la Kijiji au Mtaa tarehe... napendekeza kuwa mwombaji aliyetajwa hapo juu asajili/asisajili (futa isiyohitajika) kituo cha tiba asili au duka dawa asili kwa sababu zifuatazo (taja sababu za kukataa) Tarehe (ii) OFISI YA AFISA MTENDAJI WA KATA Wajumbe wa Baraza la Kata linalokaa kumjadili mwombaji wa fomu hii, kwanza kabla ya kumjadili muwe nazo kumbukumbu za kumjadili yeye mwenyewe alipoomba kusajiliwa kama mganga au mkunga au muuza dawa za tiba asili. Kama hakuna kumbukumbu hizo mwombaji ashauriwe kuwa apeleke fomu hii katika Kata alikosajiliwa kama mganga au mkunga au muuza dawa za tiba asili. Kwa uamuzi uliopitishwa na Kamati ya Maendeleo ya Kata tarehe napendekeza kuwa mwombaji hapo juu asajili/asisajili (futa isiyohitajika) kituo cha tiba asili kwa sababu zifuatazo (taja sababu za kukataa)..... Tarehe. 3
4 (iii) OFISI YA MKURUGENZI WA WILAYA, MJI/MANISPAA AU JIJI Kwa uamuzi uliopitishwa na Timu ya Usimamizi wa Huduma za Afya chini ya Mganga Mkuu wa Wilaya/Mji/Manispaa au Jiji, tarehe napendekeza kuwa mwombaji hapo juu asajili/asisajili (futa isiyohitajika) kituo cha tiba asili kwa sababu zifuatazo (taja sababu za kukataa)... Tarehe. (iv) OFISI YA MGANGA MKUU WA MKOA Kwa uamuzi uliopitishwa na Timu ya Usimamizi wa Huduma za Afya chini ya Mganga Mkuu wa Mkoa, tarehe napendekeza kuwa mwombaji hapo juu asajili/asisajili (futa isiyohitajika) kituo cha tiba asili kwa sababu zifuatazo (taja sababu za kukataa) Tarehe. SEHEMU YA TATU UAMUZI: (KWA MATUMIZI YA OFISI TU) 1. Ombi hili limekubalika/limekataliwa kwa sababu zifuatazo: Saini ya Msajili. Tarehe 4
5 Fomu hii iwasilishwe na vitu au nyaraka zifuatazo:- 1. Picha nne ndogo za ukubwa wa pasipoti. 2. Mapendekezo au maoni kutoka katika Kijiji/Mtaa, Kata, Wilaya/Manispaa/Jiji na Mkoa ambako mwombaji anatolea huduma zake. 3. Malipo yasiyorudishwa: Kituo cha Mganga au Mkunga au Muuza dawa* Mijini (a) Kilinge Shillingi 25,000/= (b) Kiliniki Shillingi 55,000/= (c) Zahanati Shilingi 75,000/= (d) Kituo cha Afya Shilingi 100,000/= (e) Hospitali Shillings 305,000/= (f) Ukunga wa Tiba Asili Shillingi 55,000/= (g) *Duka au Stoo ya dawa za Tiba Asili 20,000/= 1,000,000/=* kutegemea ukubwa wa duka au stoo Kituo cha Mganga au Mkunga au Muuza dawa za asili Vijijini (a) Kilinge Shillingi 5,000/= (b) Kiliniki Shillingi 35,000/= (c) Zahanati Shilingi 45,000/= (d) Kituo cha Afya Shilingi 55,000/= (e) Hospitali Shillingi 155,000/= (f) Ukunga wa Tiba Asili Shillingi 35,000/= (g) Duka au Stoo ya dawa za Tiba Asili Shilingi 20,000/= Malipo yote yalipwe katika Akaunti ya Baraza iliyoko NMB Bank House Jina la Akaunti:- Baraza la Kitaaluma Namba ya Akaunti: NMB Bank House 5
6 *Gharama za Usajili wa Kituo cha Kuuza dawa za Tiba Asili au Tiba Mbadala kutegemea ukubwa wa kituo chake* Mtanzania anayemiliki duka la dawa za asili (Dawa za kundi la 2) (a) Dawa BIASHARA MTAJI WA BIASHARA Biashara Ndogo ndogo Usiozidi shilingi milioni 5 Dawa kundi la 2 20,000 Biashara Ndogo Biashara ya kati Kati ya shilingi milioni 5 na 20 Dawa kundi la 2 30,000 Kati ya shilingi milioni 20 na 100 Dawa kundi la 2 40,000 Kati ya shilingi milioni 100 na 200 Dawa kundi la 2 50,000 Kati ya shilingi milioni 200 na 400 Dawa kundi la 2 100,000 Kati ya shilingi milioni 400 na 800 Dawa kundi la 2 500,000 Biashara kubwa Zaidi ya shilingi milioni 800 Dawa kundi la 2 1,000,000 Mtanzania anayemiliki duka la dawa za asili vijijini, usajili wa duka lake ni shilingi 20, (b) Devices, equipment FIRM CATEGORY CAPITAL INVESTMENT Micro Up to 5 millions 20,000 Small Five and Twenty millions Twenty and Hundred millions One hundred and Two hundred millions 30,000 40,000 50,000 Medium Two hundred and Four hundred millions Four hundred and Eight hundred millions 100, ,000 Large Above eight hundred millions 1,000,000 6
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