Nehru Yuva Kendra Sangathan Annexure-3
Ministry of Youth Affairs and Sports, Govt. of India
Kashmiri Youth Exchange Programme (2023-2024)
Supported by: Ministry of Home Affairs, Government India
Space for pasting
Application Form
of duly attested
(Participants and Team Leaders)
Passport Size
Name: -............................................................................................................ Photograph of the
Fathers’/Spouse Name: -................................................................................................ Participants
Date of Birth: -..................................... Age (As on 01.08.2023): ..............................
Gender (M/F/Transgender): ...............................................................................
Educational Qualification: -
....................................................................................................................
Complete Address with Pin Code: -...................................................................................................
........................................................................................................................................................................
Contact Phone/Mobile No. with STD Code (Self and Guardian both): -....................................
........................................................................................................................................................................
Email ID: -..................................................................................................................................................
Whether Member of Youth Club/NCC/NSS/Bharat Scouts Guide- Please tick……………
Experience in Youth Work or Community Service....................................................................
Vocational Training/Skills...............................................................................................................
What are your expectations from this programme ............................................................... …….
.....................................................................................................................................................................
Particulars of Bank Account:-
Bank Account Number:- Aadhar Number:-______________________
Name of Bank:-
MICR Code:- Bank IFSC Code:-___________________
Name Address and Telephone No. of Two References
Details of Reference 1:- Details of Reference 2:-
Name : Name :____________________
Address:- Address:-
Telephone/Mobile No. Telephone/Mobile No.
I undertake that the information furnished by me as above is correct as per my knowledge and
belief and that I am also giving undertaking that I have taken consent of my parents/guardian
for participation in the Kashmiri Youth Exchange Programme 2023-2024 organizing during
2024-2025.
Signature of the Applicant
(Name. ............................................. )
Place:
Date: Verified by concerned DYO/DD (signature)
Name________________Kendra (District)_________________
Nehru Yuva Kendra Sangathan
Indemnity Bond
(Participants and Team Leaders)
Kashmiri Youth Exchange Programme Annexure-5
(2023-2024)
I, , son/ daughter of
, resident of village
Distt. do
hereby declare that as a Participant of Kashmiri Youth Exchange Programme, I am willingly
participating in the programmes & activities of Kashmiri Youth Exchange Programme & that I
have given detailed information of the Kashmiri Youth Exchange Programme (including
journey to be undertaken to programme venues of Kashmiri Youth Exchange Programme and
back), and that under no circumstances will I make any claim for any loss or injury that I may
suffer in the course of the programme & activities of Kashmiri Youth Exchange Programme,
2023-2024 organizing during financial year 2024-25.
I fully understand that NYKS, MoYAS and MHA, Govt. of India will not be responsible to make
any kind of compensation in consequence of any mishap/loss/injury suffered by me during this
programme and activity.
(Signature of Participant) (Signature of Parent/ Guardian)
Name Name
Date Date_____________________
Mobile No. Mobile No.
Signature of Witness 1: Signature of Witness 2:
Name Name
Address: Address:
Date Date
Mobile No.___________________ Mobile No.______________________
Kashmiri Youth Exchange Programme
(2024-2025) Annexure-6
Medical Fitness Certificate
(Participants and Team Leaders)
(To be signed by a registered medical practitioner holding a degree not below that of MBBS)
(TO BE SUBMITTED WITH THE APPLICATION FORM)
Name (in Block letters):
Age: Gender (M/F/Trans):
Passport Size
Complete Address: - Photograph of
Candidate
Father’s Name: -
Height: - Weight:
Blood Group & Rh. Factor: Chest:
Heart &Lungs:
Vision: L: R:
Colour Vision:
Hearing:
Hernia/Hydrocele/Piles:
Remarks:
I certify that I have carefully examined Sh./Km./Sm.
Son/Daughter of Sh. , who has signed in my
presence. He/she has no mental and physical disease and is FIT to participate and undertake
long journey for attending the programme.
Signature of the Candidate Signature of the Medical Officer with seal and
Registration Number
Name:
Place:
Date:
