BIO DATA OF PARTICIPANT
Photo in uniform w/o Cap1.Name:
2.Father’s Name:
3.Home address:
4.Date of Birth:
5.Date of Joining NCC:
7.Name of School/College :
8.Course presently studying:
9.% of Marks scored in last Board/:
University Exam
10.Height:
11.Identification Marks:
12.Any outstanding achievement in Sports/
Extra curricular activities
13.NCC Activities Undertaken
S/NoEvent/ActivityDuration Date
14.Any special achievements:
15.Telephone/Mobile No:
16.Email ID:
Sig of ANO Sign of Individual
Rank & Name
COUNTERSIGNATURE OF UNIT CO
VOLUNTEERING / RISK CERTIFICATE
This is to certify that I, No Rank
Name College/School
Volunteer to attend the camp/course being held at New Delhi
from ……………………………..to …………..…………………… at my on risk.
Place : ………………………….
Date : (Signature of applicant)
Place :
Date : (Signature of Head of Institution)
CONSENT/NO OBJECTION CERTIFICATE FROM PARENTS
This is to certify that I, Father/Guardian of Cadet
No Rank Name have no objection from detailing him to RDC -2012 the camp/course being held at
New Delhi from …………………….. to …………………………
Place : ………………………….(Signature of Father/Guardian)
Date : Name :
Full Address :
SAFETY PRECAUTION CERTIFICATE
I am aware that there are a number of wells and canals near the camp RDC - 2012 at New Delhi From …………….. to ……………… And the area where the above area located is OUT OF BOUNDS. If I go there, I shall be doing it on entirely at my own risk.
Name of Institution:
Sl No / Number / Rank / Name / Year of training / SignatureI certify that the above certificate was signed by the cadet in my presence.
Place : Signature of ANO
Date : Name of School
Seal
COUNTERSIGNED
Station :
Date : OC Unit
CERTIFICATE OF PARADE ATTENDANCE
This is to certify that No Rank
Name is an NCC cadet of
under this Unit during the year 2010-2011 and 2011-2012 and the percentage of attendance on parade is as under :-
(a)2010-11…………………
(b)2011-12…………………
Unit : (Signature of ANO)
Place:
Date :
CLASS CERTIFICATE
It is certified that No Rank
Name of
(College/School) is studying in class year and he/she is in the first/second/third year of service in NCC of this Institution.
(Signature of ANO
COUNTERSIGNED
Station : Signature of the
Head of theInstitution
Date :
(Office Seal)
MEDICAL FITNESS CERTIFICATE
Certified that I have examined No Rank :
Name College/School
in accordance with the standards laid down in the NCC Act and Rules Appendix ‘A’ and found him fit to undergo strenuous training at the camp which is being held at New Delhi from ……………………………. to……………………….....….
Certified that the above mentioned cadet has been protected against Small Pox, Typhoid and Cholera.
Station : …………………..
Date : …………………..
…………………………………
(Signature of Medical Officer)
(Seal)
Name :
Designation :
No : Rank : Name :
Institution
FORM OF INDEMNITY BOND
In consideration of my being nominated at my request to undergo all types of training and also participate in any camp/course/adventure training activities in/outside NCC AND TRAVELLING. Administrator will make any claim against the Government of India or against any Officer, JCO/OR, (Armed Forces/Civilian MT Driver or against any person in the Service of the Government of India in respect of any loss or injury to the property or person (including injury resulting in death) which I am suffer while or in consequence of my being in training/ participation in camp/course. Adventure training activities in/outside NCC and traveling and understand that no compensation will be paid by the Government of India of any Officers, JCOs/OR, Armed Forces/Civilian MT Driver or against any person injury (including injury resulting death) and I agree so as to bind any Officer. JCO/OR, Armed Forcers/Civilian MT Driver and any person in the Service of Government of India against any claim which may be made by any third party against them or any of them arising our act of default on my part during or in connection of said training/camp/course. Adventure training and injury by road/rail/bus/river and flight.
The Government has agreed to bear the stamp duty on this account.
Signed by the applicantSignature of applicant
Number, Rank & Name
Shri ………………………………….. Address & Designation
In the presence of………………………………………………
………………………………………………
WITNESS………………………………………………
1.Signature ………………………Date ………………………………………..
(with date)…. …………………………………………..
Name in Block letters…..…………………………………………..
Address :…………………………………………….. Counter-Signature of Father or Guardian
2.Signature………………………………(with date)…………………………………..(with date)
Name in Block Capital LettersName in Block Capital Letters
………………………………………………………………………………………….
Address ……………………………….Address ……………………………………..
………………………………………………………………………………………….
COUNTERSIGNED BY OC UNIT
Station …………………….
Date ……………………..
ELIGIBILITY CERTIFICATE
It is certified that No: Rank:
Name: is studying in
Class/Course/Year and he/she is in the first/ second/ third/year of service in NCC Of this institution.
Date:(Signature of ANO)
AUTHENTIFICATION
I have personally checked the above particulars with the available documents and the same is correct.
Signature of Head of the Institution)(Signature of OC Unit)
DROWNING CERTIFICATE
I, know that there are deepwater area nearby the camp site and that these are ‘OUT OF BOUNDS’ to me. If I go there I shall be doing entirely at my own risk. I have been explained the precautions to be taken against drowning accidents and have understood. I have been told NOT to go near deep water in vicinity by the In-Charge. If I go to nay of these OUT OF BOUND Areas I shall do so entirely at my on risk.
Name of the NCC Directorate :- NCC Directorate ( K&L) Thiruvananthapuram
NCC Unit :
Sl No / Regt No / Rank, Name (Surname & initial) / SignatureCertified that I have explained the order regarding the precaution to be taken against drowning accident and shown all ‘OUT OF BOUND AREA’. The cadet has signed in my presence.
Station :
Date : Signature of Officer-in-Charge