death with equanimity




Refers to Section–6 of chap. 6



Note : The information provided will be kept confidential and used only as statistical data without mentioning any names.

Name Of Reporter –.

Relationship with the Kṣapaka

Section–1: General Information About The Kṣapaka (Person undertaking Samādhi–maraṇa)-

  1. Name

  2. Status – Monk/Nun/Lay male/ Lay female. –

  3. Sex – Male/Female.

  4. Age – years.

  5. Place Of Practice –

Village/ town District State


  1. Date Of Samādhimaraṇa (If aplicable) / /

dd mm yy

Section-2 : Practice Of Santhārā -

  1. Was Santhārā accepted voluntarily? YES / NO.

  2. Was the Kṣapaka in full consciousness at the time of accepting/giving the vow of Santhārā? YES / NO.

  3. Was permission obtained before accepting the vow? YES / NO.

If Yes, whose? -.

  1. What were the circumstances under which the Kṣapaka took the vow of SallekhanāSanthārā? Extreme old–age / bodily incapacitation / incurable disease / imminent danger / any other.

  2. Was permission sought before taking the vow? YES / NO.

If Yes, whose?

If No, why not?

  1. Who gave the Pratyākhyāna?

  2. Was the practice supervised? YES / NO.

If Yes, Name of the Niryāpakācārya

If No, why? -

  1. Number of Niryāpakas that attended and served the Kṣapaka in his practice

  2. Did any preparatory penance (Sallekhanā) precede the practice of Santhārā?

If Yes, how long?

Short (l up to 6 months) Medium (up to 1 year) Long (12 years) 15. Was the regimen given in the scriptures followed in the case of 12 yearlong Sallekhanā? YES / NO

16. For how long did the Santhārā (Fast unto death) last? days with water and days without water..

17. How was the Kṣapka disposed during the period of –

  1. Sallekhanā - Peaceful/ Fitful / Anxious / disturbed
  2. Santhārā – Peaceful/ Fitful / Anxious / disturbed

18. If the Kṣapaka was an Ācārya, was the practice of Gaṇasaṅkramaṇa followed?


19. Was the process of confession of own conduct–flaws and faults and expiation therefor gone through? YES / NO

20. How did the Kṣapka spend his time? In –

Scriptural study / Praying / Meditating / Preaching / Doing all these / Lamenting

21. Did, at any stage, the Kṣapka regret his decision? YES / NO

22. How was the attitude of the others –

  1. In the monastic group, .

  2. In the family, .

  3. The society at large,

  4. Media.

23. Were there any legal complications in connection with the practice? YES / NO

Section-3 – Miscellaneous Information –

  1. How was the general life–style of the Kṣapka before he/she took the vow of Sallekhanā–Samādhimaraṇa?

Very Religious / Religious / Pious / Austere/ Worldly / Careless / Sinful

  1. Did the Kṣapka observe long and severe penance often? YES / NO

If yes, some prominent penances observed by him –

  1. Did the Kṣapka often talk about the merits of the vow of Samādhimaraṇa and express a strong desire to accept this vow when his/her time came? YES / NO

  2. Whom do you consider an ideal case of the practice of Samādhimaraṇa in your tradition?

  1. a. Are the practices of –

  1. Utkṛṣṭa Sallekhanā,

  2. Iṅgini-maraṇa and

  3. Prāyopagamnamaraṇa

possible in the present time and period?

  1. If YES, cite instances

  2. If NO, why not?

  1. How was the dead body of the Kṣapakadisposed of?

Ceremoniously / with reverence / with devotion.

  1. Any other information you would like to provide/ volunteer –

Place :

Date : Signature

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