1
INDEMNITY CERTIFICATE
In consideration of my being nominated at my request as a participant in any Camp/course/Adventure Trg activities (like
Mountaineering, Rock Climbing, Trekking, Hiking, Skiing, Cycling & India against any officer JCO/OR Civilian MT Driver or against
any person in the Service of Govt. Of India in respect of any loss or Injury to the property or pardon (Including injury resulting in
death) which I may suffer while of inconsequence of my being participated & I understand and that no compensation will be paid by
the Govt. Of India or any Officer JCO/OR Civilian MT Driver and in respect of any such loss or Driver and any person in the service
of Govt, of India against any claim which may be any third party against them or any of them arising out of any act of default on my
part during or in connection of said training and journey.
Station : Kanpur .....................................................
Date: ........................ (Sign of Applicant)
In the presence of witness Name in block letter ……………………………
1. Signature……………………………. Address …………………………………………….
Name in Block Letter…………………………. ……………………………………………………….
Address……………………………..………….
…………………………………………………..
2. Signature…………………… (Sign of Parent/Guardian) ...............................
Name in Block Letter…………………………. Name in Block Letter ………………………..…….
Address……………………………..…………. Address …………………………………………….
…………………………………………….……. …………………………………...…………………. [
DROWNING / ACCIDENT CERTIFICATE
I know that there is deep water near the Camp site, en-route and that the area of water is out of bounds. If I shall go there,
I shall do so at my own risk.
I have been explained the orders regarding precautions to be taken against drowning accident and have understood them.
I have been told not to go near deep water in the vicinity of the Camp site by the Officer-in-Charge. If I go to anyone of these out of
bound areas, I shall do so at my own risk.
Name of College :
Name of Unit : 03 UP Air Sqn NCC, Kanpur
Name of Gp HQ : NCC Gp HQ Kanpur
Name of Dte : Lucknow (UP)
S No Regt No. Rank Name of Cadet Sign of Cadet
1.
Certified that I have explained the orders regarding precautions to be taken against drowning accident and shown the “Out Of
Bound Areas” to the cadet. The cadet has signed in my presence.
…………………………. ……………………………
Sign of NCC Officer Sign of Principal/Headmaster
Seal Seal
COUNTERSIGNED
(Sign of Commanding Officer)
Station: ................... Seal
2
RISK CERTIFICATE
This is to certify that I No................................................. Rank .....................Name ...........................................
Father’s Name .................................................College .................................................... Unit 3 UP ANCC Kanpur
Volunteer to attend the ........................................................Camp/Course being held at .............................................................
From ...................................... to ..........................................
Station : Kanpur (Sign of Applicant)
Date: ........................ Address.................................................
................................................................
................................................................
PARENT’S CONSENT CERTIFICATE
This is to certify that I have no objection to spare my son /daughter Regimental No ...............................Rank .....
Name .............................................. College ........................................ Unit 3 UP Air Sqn NCC, Kanpur
to attend the ..................................Camp being held at ............................................ From ............................ to .................. .
Station : Kanpur (Sign of Parent/Guardian)
Date: ........................ Name & Mobile No. both parents
Under mentioned items are not advised to carry to the camp location.
(1) Smart Phone (2) Cash not more than two hundred rupees. (3) Jewellery ,expensive clothes and any other valuable
items (4) No Knife .
Cadets can carry basic mobile phones on their own risk. No cadets will claim for the same if lost.
3
MEDICAL CERTIFICATE
(a) It is certified that I have examined No ................................................ Rank .......................................... Name
.............................................. College .................................................... Unit 3 UP Air Sqn NCC, Kanpur and found
him fit to undergo training of strenuous nature on the ........................................................Camp/Course being held at
............................................ From .................................. to .............................. .
(b) I also certify that the above mentioned cadet has been inoculated/vaccinated.
Station : ................... (Sign of Medical Officer)
Date: ........................ Seal
