NATIONAL CADET CORPS SENIOR DIVISION/WING ENROLMENT FORM ‘opera’ Revised 2013) {See Rules 7 and 11 of NCC Act, 1948) ATTESTED PP SIZE ‘COLOR 1 Name(INBLOCK LETTERS) 2. Nationality & Date of Birth (DDIMMIYYYY) 3. Father's Guardian's Name 4 Mother Name 5 Permanent Address 6 Mobile/Land Line Telephone Number 7 E-mailD 8 Blood Group 9 Sex 10 Nearest Railway Station ‘11 Nearest Police Station 12 Educational Quifications & ‘Marks in (%) 18. ‘dentification Marks (atleasttwo) Haveyoueverbeenconvicedby actiinal cout &ifsoinwhat Ccrommastnossandwhatwasthe senlonce ?Atachrevantdocurents 15 Name of SchoolCollege and ‘Stream(Avts/Science/Commerce) 16 Wiling to be enraled and undergo training under the National Cadet corps Act, 1948 17 NCC Unitto be enrolled IN. 18 HaveyoubsenenroledinNOCeatier, Ifyes, Your Enrolment No. 18 Have you ben dismissed from NCC the tetova Armyftha Indian Amed Forces, Please Provide details - EEF Scanned with CamScanner8 Date ‘Nexto sonst “leone No (0}/( (a appa) 21 Bankers detalstFSC Code 2 Bank Account No of CadeuParent 23 AachaarJIO No, (it alted) 24 PAN Cardo, (tated) Proce Fisionce For wih aces (thr (Signature ofthe applicant) DECLARATION ON ACCEPTANCE FOR ENROLMENT 1LIsolemrly decare thatthe answers Ihave given tothe questionsin this form are ture and that no part of themisfals,and that am willing to full the engagement made. Dane -~promise that will honestly and faithfully serve my country and abide by the Rules & Regulation ofthe National Cadet Corps that will tothe bestof my ability, attend all parades and campsasmay berequired by the Commanding Officer from timeto time. ~-further promise thatafter enrolment, willhavenoclaimon authorities forany Compensation in the eventof injury or death due to accident during training camps, courses, ‘ravelling and while on YEP or any other such NCC events like RDC and IDCT understand Ihave no service Signature ofthe Applicant DECLARATION BY PARENT/ GUARDIAN 1Isolemnly declare thatthe answers givenin this form ae trueand thatno patof them sfalseand that my son / daughter /ward is willing to fulfil the engagement made, ie promise thatafter the enrolment of my son/ daughter ward, Iwillhave "oclaim onauthortesforany compensation in theeventof any injury or death due toaccident during taining ‘amps, courses, travelling and while on YEP or other suchNCC eventslike RDCand IDC Signature ofthe Applicant Scanned with CamScanner\ (3) CERTIFICATE Certified that applicant and his parent/guardian understand and agree tothe conditions of enrolment Signature of Enrolling officer TO BE COMPLETED BY MEDICAL OFFICER BEFORE ENROLMENT Thaveexamined (Name).. on (date) and consider him/her fit/ unfitforenrolmentasaCadetin the TO BE USED FOR EXTENSION OF ENROLMENT (GeeRules13) ‘A. agree toextend my enrolment for one year and am willing to ulti theengagement made. Signature of the applicant Sito Commadig Ofer Signature fParent/ Guardian Signature of Principal NOTE—This form will beretained in the school in which the unitis located Scanned with CamScanner(4) Indemnity Bond To, ‘Tho President of India, Tn consideration of my wand No. evealfames being nominated liber bythe NCC alors oF a ls own request aga pthc any NCC camp (whee Republic Day Camp and Independncé Day Camp in Deli). Cour Adventure Trang (Inluding Army, Navy & Air ‘Wing activin ax th ease shay bo) and while traveling (i domeststnemadonalnurface, al and water transport ani tending Youth Exchange Programmes abrond, I undertake nd agree that nether I, nor my other legal representatives will make any claim aginst the Government or against NCC authors tntuding officers, JCO'MNCO's or equivalent rom Navy and Air Fore, evils, MT dvers or aguinst any tbe uch pernon nthe service of the Government, in respect of ny Joss or injury-to the propty or person Including injury resulting In dea, dye to any reasons whatsoever which my ‘ward may suffer, while ori consequence of hs participation nthe aboveativiis and {understand that no compensation willbe paid the Government or NCC authorities inching offices, JCO'sINCO's orequlvalents from Navy and Air Force ‘orcivillan MT drivers in espect of any such Loss or Injury and T agree as to hind myself my executors and administrators and osher Jeg representa to Kndermlly the Goverinent or NCC authors including officers, JCO'SNCO's or csquivalents from Navy aid Ait Force, lvillans AT elves or tly person into service’ Government agalnst any claim ‘which may be fom any third party agalnst them or any of them arising out of any act of default on his.part ducing or in ‘connection with the said camps, courses, adventure training, travelling and while on Youth Exchange Programme oF any ‘other such NCC actives as may be organised frm time to time within or ouside the Uaion of India, ‘Signature of Applicant Now Name... Unit/Group.. Signature of Parent/Guardian Name. NOTE: it InCase ofS Applicantbeinga minor Indemnity Bond applicable to Minor willbe used Fsmecrat Scanned with CamScanner‘Append A' {olotter No, 199sa/DGNCC/CWS dated 05 Feb 01, NOMINATION FORM FORTHE MEMBERSHIP OF THE NCC CADET WELEEARE SOCIETY (Tobe rotnined atNCC Group Hs) 1, |, Cadet (Name in block letter). ‘SorvDaughter of Shri (Namo in block lottrs), student of Class NCC on (date)... ith 35 MP Bn NCC Shivpurl apply for membership of the NCC. Caxlot welfare Society and hereby subscribe as sum of Rs. 6/- (Rupees Six only) to wards membership feo. 2. Myfather/mother/guardian's occupation and the annual income of my family from all sources is Rs, oer annum. 3. understand that | shall be entitled to financial relie as determined by the Governing Body \Wanaging Committee of the above society in the event partial or permanent disablement sus tained by me while participating in an oranised NCC activity. Ihereby accept that the decision of the Governing body. Managing committee with regard to the quantum of relief to be paid to me in the event of my partiaN permanent disablement willbe final and binding on me. 4, hereby nominate the following Person\persons who will receive financial assistance as. per the share where indicated and as determined by the Governing body/Managing Committee of the ‘above society, which willbe final and binding onthe following person(s) inthe event of my death While participating in an organised NCC activity - Permanent Percentage of it Ser enters Age — address ofthe | financial assist- No, | Nominees (in block letter) with the cadet | MT Orin ‘ance payable (Tobe fled by the cadet in own hand writing) 5. My membership in the welfare society and this Nomination willbe valid only til shch time | remain a cadet in the Division or wing of the NCC which | have been enrolled Plack ia : Dated: (Full Signature of the NCC cadet) Continue Scanned with CamScannerPlace: Dated (Signature of NCC officer/Head of Institution and office seal) ‘SECTION -Iit {1am willing to allow my son\daughterhvard Name, , become a member of the NCC cadet / Welfare Society under the terms and conditions and rules in force of the sociaty. | also approve of the nomination made in Section -1 Place: (Full Signature of Father/Guardian with complete address) win NATURE WITH FULL ADDRESS. FICE SEAL 1. Signature. 2 Signatur (Fullname, (Fullname. Address... Address. (Office Seal i any) (Office Seal if any) Note :- The witnesses should be either Head of Institution NCC Associated Officer\Sarpanch Vilage. Head. SECTION -IV Received a sum of Rs. 16/- (Rupees Fifteen Only) as one time subscription and enrolled asa __ membership of the NCC Cadet Welfare Society during the Cadetship in the Junior/Senior Division’ (Signature of CO Unit) SECTION -V (To be filled in by the NCC Unit) Date of despatch of the Nomination form to Group HOs Gwalior. pea) Scanned with CamScanner